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YOJANA
Website: www.yojana.gov.in

May 2018 Volume-62

Since 1956 A DEVELOPMENT MONTHLY


CHIEF EDITOR Let noble thoughts come to us from all sides
Deepika Kachhal Rig Veda
Senior Editor
Shyamala Mani Iyer In This Issue
Editor
Kulshrestha Kamal
Joint Director (Production)
Vinod Kumar Meena Creating Mass Movement to Financial Inclusion in India:
COVER DESIGN
address Malnutrition Challenges and Way Forward
Gajanan Pralhadrao Dhope Rakesh Srivastava............................ 7 Charan Singh................................. 30
Our Representatives special Article Boosting Infrastructure to
Ahmedabad: Janhavi Patel, Bengaluru: B.K. Kiranmai
Bhubaneshwar: Girish Chander Dash, Chennai: fuel Development
Sanjay Ghosh, Hyderabad: Vijayakumar Vedagiri, Food to Nutrition Security Hiranmoy Roy................................ 35
Jalandhar: Gagandeep Kaur Devgan, Kolkata: M S Swaminathan.......................... 11
Khurshid Malik, Mumbai: Umesh Sadashivarao Stretching A Hand to the
Ujgare: Thiruvananthapuram: Roy Chacko Role of health services in Vulnerable
nutrition V Srinivas....................................... 40
Chief Editor’s Office : Room No. 660, Soochna
Bhawan, CGO Complex, Lodhi Road New Delhi Prema Ramachandran................... 14
110 003 Phone: 24362971 Expanding Universal Health
Yojana (English): Room No. 647, Soochna Bhawan, Accountability for Nutrition Coverage
CGO Complex, Lodhi Road, New Delhi - 110 003. Outcomes Manisha Verma............................. 45
E-mail (Editorial) : yojanace@gmail.com
Chinmaya Goyal............................ 21
YOJANA seeks to provide a vibrant platform for
discussion on problems of social and economic
Decentralised Approach to
development of the country through in-depth focus Tackling Nutrition
analysis of these issues in the wider context of
Avani Kapur................................... 52
government policies. Although published by Nutritional Status in India
the Ministry of Information and Broadcasting,
YOJANA is not restricted to expressing the official Shamika Ravi................................. 25 Shaping Food Consumption
point of view.
Pullaiah Dudekula.......................... 60
DISCLAIMER: The views expressed in various
articles are those of the authors' and they do not
necessarily reflect the views of the Government
or the organisation they work for. l Maps/flags
used in the articles are only indicative. They don't
reflect the political map or legal representation Regulars
of the flag of India/any other country. l The
readers are requested to verify the claims
made in the advertisements regarding career
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Website: www.publicationsdivision.nic.in YOJANA is published in Assamese, Bengali, English, Gujarati, Hindi, Kannada, Malayalam, Marathi, Odia,
@DPD_India Punjabi, Tamil, Telugu and Urdu.
4 YOJANA May 2018
YOJANA
NUTRITION: KEY TO DEVELOPMENT

W
ith a population of about 1.2 billion as per 2011 census, India is likely to be
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the most populous country on this planet by 2030 with 1.6 billion people. It
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currently accounts for more than 17 per cent of the global population. Thus  
   

ensuring food and nutrition security is a challenge for India. A healthy workforce is a
prerequisite to any nation’s development. Recognising this fact, improvement of the
         

health and nutritional status of the population has always been given high priority.   

        


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Article 47 of the Constitution of India states that “the State shall regard raising the " 

      

level of nutrition and standard of living of its people and improvement in public health  



      


among its primary duties”.


 

Indian policymakers have always given priority to ensuring health and food
safety.  Successive five-year plans  have laid policies and multi-pronged strategies #   
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to improve food security and nutritional status of the population in a specified time

                   
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frame while also providing requisite funds.  The government has been giving extensive
importance to universal access to efficient and basic health services in both urban and rural areas. As a result,
famines and severe food insecurity are no longer a threat though seasonal food insecurity continues to raise its head
in different pockets of the country. There has been a substantial improvement in nutritional status of all the segments
of the population with a substantial reduction in cases of undernutrition and micronutrient deficiencies.
The challenge of maternal and child undernutrition remains a national public health concern and a policy priority
for the current government. India is home to over 40 million stunted and 17 million wasted children (under-five years). 
Undernutrition is a condition resulting from inadequate intake of food or more essential nutrients resulting in
deterioration of physical and mental health. Regional disparities in the availability of food and varying food
habits lead to the differential status of undernutrition which is substantially higher in rural than in urban areas.
This demands a region-specific action plan with significant investments in human resources with critical health
investments at the local levels.
The announcement of the National Nutrition Mission (NNM) is a very significant development on this front.
It has introduced a central nodal agency with extensive financial resources to coordinate various central and state
government schemes and imbue them with additional financial resources. The programme will cover all states and
districts in a phased manner. The total outlay for the nutrition mission has been set at over Rs. 9,000 crore for a
period of three years. The core strategy of the mission is to create decentralized governance system with flexibility
given to states, districts and local level with robust monitoring, accountability and incentive frameworks that will
encourage local solutions. The programme, through well-defined targets, strives to reduce the level of stunting,
under-nutrition, anaemia and low birth weight babies. More than 10 crore people are likely to be benefitted by
this programme. 
Healthy eating practices are akin to behavioural change. Government interventions and large-scale participation
of communities are must to motivate the people towards the right practices. NNM proposes to cover all the States
and districts in a phased manner i.e. 315 districts in 2017-18, 235 districts in 2018-19 and remaining districts in
2019-20. The main emphasis is on creating synergy, ensuring better monitoring and encouraging States/UTs to
achieve the targeted goals. With such clear operating roadmap, the NNM is perhaps the most ambitious programme
of the government.
Healthy people can contribute to the nation’s growth only when supported by adequate infrastructure and
facilities. Thus while taking steps to ensure healthy India, the government has also taken extensive measures to
ensure the financial and social security of the citizens. This clubbed with moves to create strong infrastructure
and missions like swachh bharat, skill India and digital India campaigns are sure to put India in the forefront on
the world map. 

YOJANA May 2018 5


YE-812/2018

6 YOJANA May 2018


Poshan Abhiyaan
multi pronged approach

Creating Mass Movement to address Malnutrition

Rakesh Srivastava

t is a known fact that through convergence and lays-down

I undernutrition is an
outcome of not one but
multiple detrimental
factors. These factors
play their role in helping sustain this
specific targets to be achieved across
different monitoring parameters
over the next few years. To ensure
a holistic approach, all 36 States/
UTs and districts will be covered in
continuous burden of undernutrition; a phased manner i.e. 315 districts
leading to our inability to achieve in 2017-18, 235 districts in 2018-19
our desiredhuman resource potential, and remaining districts in 2019-20.
generation after another. In order to More than 10 crore people will be
achieve its true potential and play benefitted by this programme. Never
the role as a global superpower India before has nutrition got so much
In order to achieve its true will need to focus on eradication prominence at the highest level in
of malnutrition so as to ensure the country.
potential and play the role that the coming generations are
as a global superpower healthy, enabling higher intellectual Different Ministries/Departments
potential, leading to enhanced work at the Centre and States/UTs deal
India will need to focus on productivity. This one factor will with varied interventions required
eradication of malnutrition enable us to connect the dots between for reduction of malnutrition in
so as to ensure that the schemes like Make in India, Digital a stand-alone manner. State/UT
India, Skill India and grow to our being the highest implementing
coming generations are desired potential as a Nation. agency for all such schemes, it
healthy, enabling higher On March 8, 2018; the Prime
is pertinent to achieve synergy
intellectual potential, of all interventions to effectively
Minister launched POSHAN
target malnutrition. POSHAN will
leading to enhanced work Abhiyaan – PM’s Overarching
provide the required convergence
Scheme for Holistic Nourishment
productivity. This one from Jhunjhunu in Rajasthan. The platform for all such schemes and
thus augment a synergized approach
factor will enable us to programme through use of technology,
towards Nutrition. Convergence at
a targeted approach and convergence
connect the dots between strives to reduce the level of stunting, centre is being achieved through
schemes like Make in under-nutrition, anemia and low formation of the National Council
birthweight in children, as also, for Nutrition and the Executive
India, Digital India, Skill Committee for POSHAN Abhiyaan.
focus on adolescent girls, pregnant
India and grow to our women and lactating mothers, thus Both these draw members from all
desired potential as a holistically addressing malnutrition. the stakeholders of the Abhiyaan.
The programme aims to ensure Similarly, the Convergence Action
Nation Plan at State, district and block
service delivery and interventions by
use of technology, behavioral change level define the implementation
The author is Secretary, Ministry of Women and Child Development, Government of India. He has vast experience in the area of
nutrition, women welfare and implementing large scale governmental programmes.

YOJANA May 2018 7


ensure a holistic appproach, all 36States/UTTs and districcts will be covered
c in aphased mannner i.e. 3155
districts in 2017-18, 235 districcts in 2018-19 and remaining distriicts in 2019--20.More thhan 10 croree
people will
w be beneffitted by thiss programmee. Never befoore has nutrition got so much prominence at thee
highest level in the ccountry.

The software application, ICDS-


Common application Software
especially developed for this purpose
enables data capture, ensures assigned
service delivery and prompts for
interventions wherever required. This
data is then available in near real time
to the supervisory staff from Block,
District, State to National level
thorough a Dashboard, for monitoring.
The procurement and distribution
of mobile devices is a part of the
project. The application is aimed
to augmentsystem strengthening in
Figure 1: Components of POSHAN Abhiyaan ICDS service delivery and looks at
improving the nutrition outcomes
and monitoring mechanisms for the convergence platform at village
through effective monitoring and
Abhiyaan. The Very High Speed level, for participation of all frontline
timely intervention. The software
Network (VHSN) day provides the functionaries.
allows the capture of data from the
field on electronic devices (mobile/
tablet). It enables collection of
information on ICDS service delivery
and its impact on nutrition outcomes
in beneficiaries on a regular basis.
This information is available to the
States and MWCD on real time
basis on web-based dashboards. It is
aimed to improve the ICDS service
delivery and also enable the Mission
to effectively plan and take fact-based
decision making.
The problem of malnutrition is
inter-generational and is dependent
on multiple factors which, inter-alia,
Figure 2: Convergence Matrix
include optimal Infant & Young
The Abhiyaan empowers the workers and Lady Supervisors by Child Feeding (IYCF) practices,
frontline functionaries i.e. Anganwadi providing them with smartphones. Immunization, Institutional Delivery,
Early Childhood Development,
Food Fortification, Deworming,
access to safe drinking water and
proper sanitation (WASH), Dietary
diversification, and other related
factors. Therefore, to address the
problem of stunting, under-weight
and wasting, especially in children,
there is a need to take-up sustained
efforts requiring multi-pronged
approach and bring grass-root
synergy and convergence. The
problem can finally only be addressed
through a socio-behavioural change.
This aspect of POSHAN looks at
deploying a multi-pronged approach
to mobilise the masses towards
Figure 3: ICDS- Common Application Software creating a nutritionally aware

8 YOJANA May 2018


society. Community based events at anaganwadicentres
to engage the beneficiaries and their families towards
nutritional awareness; sustained mass media, multimedia,
outdoor campaigns; and synergized mobilization of all
frontline functionaries, self-help groups and volunteers
towards nutrition, are the methods to be adopted. The aim
is to generate a Jan Andolan towards Nutrition.
Ministry of Women and Child Development is the
nodal Ministry for anchoring overall implementation;
as described above, the vision is for all these Ministries
to work together for addressing undernutrition. Never
before has so many programmes been pulled together for
addressing undernutrition at national level in India. The
Prime Minister Office will review the progress every six
months and similar review is expected at state level; and
this process will be augmented by nutrition specific review
in every district by the District Magistrate on a quarterly
basis every 10 th January, April, July and October. As the
National Family Health Survey (NFHS-4) highlights that
inter-state and inter-district variability for undernutrition
is very high, so every state/district needs to develop its
Convergence Action Plan which includes their specific
constraints and bottlenecks and what can they address
in short, mid or long term. It is very important that we
put all the necessary processes in place before we start
expecting miraculous changes in the undernutrition burden
across the country. This Abhiyaan is going to be linked
with incentives for the front line workers like Anganwadi
workers for better service delivery, for the team based
incentives for Anganwadi workers, ASHA and ANM for
achieving targets together; and for early achiever states and
UTs. For the non-performing states/UTs/districts/blocks/
Anganwadi centers there would be focused support and
hand holding to make them start performing better.
Thus, the POSHAN Abhiyaan is to bring all of us
together, put accountability and responsibilities on all
stakeholders, to help the Country accomplish its desired
YE-821/2018

potential in terms of its demographic dividend of 130 Crore


human resource.  q
(E-mail: secy.wcd@nic.in)

YOJANA May 2018 9


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10 YOJANA May 2018


balanced Nutrition
special Article

Food to Nutrition Security

M S Swaminathan

ince 1947, achieving food and primary healthcare”.  Further I

S security has been a major


goal of our country. This
was because the Bengal
Famine created awareness
of the need for paying priority attention
stressed the need for a food based
approach to nutrition security and not
a drug based one. Now after 30 years,
the concept of nutrition security is
gaining ground. MSSRF is planning
to the elimination of hunger. Our Food to demonstrate how agriculture, health
Security Act 2013 specially mentions and nutrition can enter into a symbiotic
the need for nutritional security (An relationship. In the area of nutrition
Act to provide for food and nutritional security, it is important to look at
security in human life cycle approach, food adequacy, protein deficiency and
Government has approved a deficiency of micronutrients like iron,
by ensuring access to adequate quantity
iodine, zinc, vitamin A etc. The Farming
National Nutrition Mission of quality food at affordable prices to System for Nutrition (FSN) developed
people to live a life with dignity and by me provides a methodology for
with a three year budget for matters connected therewith or achieving such symbiotic linkages.
of Rs. 9,000 crore. This is incidental thereto). Above all, a global grid of genetic
government’s response to  I would like to briefly indicate how gardens of biofortified plants will be
an important tool for fighting hidden
the widespread malnutrition this can be achieved by harnessing
hunger. MSSRF plans to demonstrate
the tools of agriculture, nutrition and
resulting in children with health in an integrated manner. Both
the power of food based approach
impaired cognitive abilities. in some high malnutrition burden
food and non-food factors will have to districts such as Thane in Maharashtra,
The Nutrition Mission to receive concurrent attention. Some of Gorakhpur in Uttar Pradesh, Koraput in
the steps needed for this purpose are Odisha and parts of Tamil Nadu.
be successful should be briefly indicated below.
designed on a mission mode National Nutrition Week
Food to Nutrition Security
with symbiotic interaction It will be worthwhile to spend
among components and In 1986, both in my lecture at FAO National Nutrition Week and other
and in a book on “Global Aspects of such events in generating awareness
with a Mission Director Food Production” I stressed the need of the implications of malnutrition
who has the requisite for a change in emphasis from food particularly with reference to brain
security to nutrition security. I also development in the child. As an action
authority coupled with defined nutrition security as “physical programme, it will be useful to launch
accountability economic and social access to balanced a National Grid of Genetic Garden of
diet, clean drinking water, sanitation Biofortitifed Plants. It will help us to
The author is Founder Chairman, M S Swaminathan Research Foundation. He has been described as "the Father of Economic Ecology".
He has held many posts in international and national committees like Chairman of the UN Science Advisory Committee Independent
Chairman of the FAO Council, Chairman, National Commission on Farmers and Director General, International Rice Research Institute,
the Philippines. He has won many awards like the Ramon Magsaysay Award for Community Leadership, the first World Food Prize in
1987, the Mahatma Gandhi Prize of UNESCO. He is the recipient of Padma Shri (1967), Padma Bhushan (1972) and Padma Vibushan
(1989). Professor Swaminathan is a Fellow of many of the leading scientific academies of India and the world, including the Royal
Society of London and the U S National Academy of Sciences.

YOJANA May 2018 11


provide agriculture remedies to major
nutrition problems particularly affecting
the poor. These events provide a great
opportunity to launch a programme
for the nutritional well being of our
population.
Making National Nutrition Mission
a Success
Government has approved a
National Nutrition Mission with a
three year budget of Rs. 9,000 crore.
This is government’s response to the
widespread malnutrition resulting
in children with impaired cognitive
abilities. The Nutrition Mission to
be successful should be designed
on a mission mode with symbiotic
interaction among components and with of improved post-harvest Prime Minister launched a pan India
a Mission Director who has the requisite management. National Nutrition Mission covering
authority coupled with accountability. all the 640 districts of the country.  To
Earlier Missions were not successful  In addition to the above, there is achieve the goals of the National
because the concept of the Mission was need within the mission for provision Nutrition Mission, the following five
not fully operationalised. For example of clean drinking water, sanitation, areas need concurrent attention. 
the Nutrition Mission should have the primary health care and nutrition
following interactive components to literacy. Further we must ensure that 1. Overcoming calorie deficiency
make it a success: Community Hunger Fighters well through the effective use of the
versed in the methods of applying provisions of the National Food
l Overcoming undernutrition through
agricultural remedies to nutritional Security Act 2013
the effective use of the provisions
of the Food Security Act and also maladies are trained with the help 2. Overcoming protein hunger through
taking advantage of the enlarged of agriculture universities. The the increased production and
food basket which includes millets Nutrition Mission should have proper consumption of pulses and milk
in addition to rice and wheat. monitoring tools so that the efficacy and poultry products.
of the intervention can be judged. 3. Overcoming hidden hunger caused
l Assuring enough protein intake Thus the term Mission should not
through increased pulses production by micro nutrient deficiency through
only be in terms of a project title but the establishment of genetic gardens
and increased consumption of milk more importantly in the procedure of
and poultry products. of biofortified plants and promoting
implementation through synergy and
a Farming System for Nutrition
l Overcoming the hidden hunger symbiosis among different components
programme.
caused by micronutrient malnutrition of balanced nutrition.
through the establishment of genetic 4. Ensuring the availability of clean
gardens of biofortified plants. National Nutrition Mission drinking water, sanitation and
primary health care.
l Ensuring food quality and safety On the occasion of the International
through steps for the adoption Women’s Day on March 8, 2018 the 5. Developing a cadre of Community
Hunger Fighters who are well
versed with the art and science of
malnutrition eradication. 
If all the above five areas are
attended to concurrently, we can
achieve the goal of the National
Nutrition Mission.
Endnote
Ref: Swaminathan, M.S. and S.K.
Sinha (1985).  Global aspects of Food
Production.  Tycooly International
Publishing Company, Dublin. q
(E-mail: swami@mssrf.res.in)

12 YOJANA May 2018


YE-814/2018

YOJANA May 2018 13


nutrition centric planning
assessment

Role of health services in nutrition

Prema Ramachandran

hen India became programmes, provided the needed

W independent, the
country faced two major
nutritional problems: a
threat of famine and the
funds and laid down targets to be
achieved in the defined time frame.
Progress was monitored through the
national surveys.
resultant acute starvation due to low
All the national nutrition and health
food production and the lack of an
surveys carried out over the last four
appropriate food distribution system.
The other was chronic under-nutrition decades have documented that there
due to poverty, food insecurity and have been steady but a slow decline
inadequate food intake. Famine and in under-nutrition and micro-nutrient
In the dual nutrition and starvation hit the headlines because deficiencies, morbidity and mortality
health burden era, assessment they were acute, localised, caused due to severe infections. Because of
of nutritional status is an profound suffering and fatalities. the synergistic interactions between
nutrition and health, some health
important component of both But chronic low food intake was a
widespread silent problem leading to interventions resulted in improving
public health interventions both health and nutritional status and
under-nutrition, ill health and many
and care of individuals seeking more deaths than starvation. Mutually vice versa. In the last two decades,
health care. Ideally, nutritional reinfor cing adverse consequences of there has been a slow but steady
assessment should be carried out under-nutrition and ill health resulted increase in the prevalence of over-
periodically in all individuals in high morbidity and mortality in all nutrition and non-communicable
age groups and the longevity at birth diseases (NCD). The population is
and more often in vulnerable not fully aware of the adverse health
was only 35 years. Recognising that
segments of the population consequences of over-nutrition and
optimal health and nutrition were
such as children, adolescents, essential for human development and tends to ignore obesity. NCDs are
pregnant and lactating women human resources were the engines asymptomatic in the initial phase; only
and elderly citizens. Neither driving national development, Article after symptoms due to complications
47 of the Constitution of India states arise do patients seek health care.
nutrition and health services nor It is essential to improve awareness
“the State shall regard raising the
our population, are geared for regarding health consequences of
level of nutrition and standard of
such routine periodic assessment living of its people and improvement adiposity and initiate programmes
for early detection, appropriate in public health among its primary for prevention and management of
counseling and effective duties”. The country adopted multi- adiposity. Simultaneously interventions
sectoral, multi-pronged strategies to for regaining normal nutritional status
management of nutritional
in those with NCD will have to be
deficiencies and excesses before improve the nutritional and health
initiated as a part of the management
status of the population. Successive
clinical problems arise Five-Year Plans documented the of NCD. This article will briefly review
policies, strategies and intervention the role of health services in addressing
The author has worked for 25 years in Indian council of Medical Research. She joined Planning Commission as Adviser
(Health, Nutrition and Family Welfare). At present, she is Director, Nutrition Foundation of India, New Delhi.

14 YOJANA May 2018


Fig 1

60.0 in pre-school children (Figure 2).

51.8
Data from NFHS 2, 3, and 4 showed

46.0
similar trends between 1990 and 2015

40.5

37.8
37.6

36.8
(Figure 3). During this period there

34.5
40.0
Prevalence %

was sustained a reduction in infant

29.5
26.7
mortality rate (IMR) and under-five
25.7

21.9
26.5 mortality rate (U5MR) (Figure 4).

23.9
20.0 Infections were the major causes of

22.3

21.6
U5MR; the steady decline in U5MR
between 1970 and 2015 was due to
substantial improvement in access to
0.0
6-11 12-23 24-35 36-47 48-59
health services for immunization and
mths mths mths mths mths treatment of infections in under-five
Age (months) children. Prevention and treatment of
not recd any AW services recd food supplements almost daily
not weighed at all
infections reduced energy loss due to
infection and prevented deterioration
Fig 1 Figure 1. Coverage under ICDS (NFHS4) in nutritional status. Thus, improved
Fig 2
the nutrition challenges in the dual dietary intake. Another component access to healthcare played an
60.0burden era. important role in achieving a steady

51.8
nutrition of ICDS programme was weighing
100 reduction in the under-nutrition rates
children for early detection of growth
A decline of 77.5 under-nutrition 78.6 46.0 in pre-school children in the last four
68.6 faltering and under-nutrition and
40.5

75 65.1 decades.
% %

62.4

37.8
37.6

P r e - s c h o o l c h i l d r e n60.1w e r e initiating appropriate57.7 management


36.8
Prevalence

34.5

40.0 of under-nourished 49.3 45.7


children. Though Optimal nutrition in childhood
recognized
50 as the vulnerable group 41.1
29.5
Prevalence

initiated in the seventies, ICDS was


26.7
25.7

prone to under-nutrition and ill


universalised only in the first decade Indian children
22.5 are short and

21.9
health.
25 Under-nutrition in pre-school 18.1 19.9 18.5 15.5 birth. As
26.5

children renders them susceptible of the new century. Over decades underweight right from
23.9

20.0 infections aggravate there has been an improvement in birth weight is a major determinant
22.3

to infections;
21.6

0 of growth, low birth weight children


under-nutrition and micro-nutrient the coverage under both components
Wt for
deficiencies. Severe or repeated age<-2SD of ICDS Ht
but for
dataage
from <-2SD
the National BMI
grow for
along age
a <_2SD
lower trajectory of
i n f e 1975-79
c t i o n s i n u n1988-90
d e r- n o u r i s h1996-97
ed Family 2000-01
Health Survey 2011-12
(NFHS)-4 growth during infancy, childhood
and adolescence. As a result, nearly
children 0.0if left untreated could result showed that even in 2015 coverage
Fig 3 under both the components still half of the children are classified as
in death. 6-11 high priority
Therefore 12-23was 24-35 36-47 48-59 stunted and underweight. Height,
remains suboptimal (Figure 1). Data
mths under-nutrition
accorded to reducing mths mths mths mths
in pre-school children. The Integrated from surveys carried out by the weight and BMI are three parameters
Age (months)
51.6
C h i not
l d recd
D e vany
e l oAW
p m services 50.9 recd food
e n t S e r v i c e s National supplements
Nutrition Monitoringalmost daily widely used for assessing nutritional
Bureau
(ICDS) not was
50 weighed
aimed at at
all providing food (NNMB) indicated that despite poor
45.6 status. Of the three, BMI Body
42.3
Prevalence %

40.9
supplements to children from poor and coverage under ICDS, there has 38.7 Mass Index which is the indicator
38.4
36.5
marginalized sections to bridge the been a slow but steady reduction in of current energy adequacy 35.7 has long
Fig 2 been accepted as the indicator for
gap between requirement and actual the prevalence of under-nutrition 29.4
30
20.8 20.7 21
100 18.3
15.1
77.5 Stunting 78.6
under weight Wasting
75
10 68.6 65.1
Prevalence %

NFHS 1 u-362.4 60.1NFHS 2 u 3 NFHS 3 u 3 RSOC u-5 NFHS 4 u 5


57.7
Survey
49.3 45.7
50 41.1

22.5
25 18.1 19.9 18.5 15.5

0
Wt for age<-2SD Ht for age <-2SD BMI for age <_2SD
1975-79 1988-90 1996-97 2000-01 2011-12
Figure 2. Prevalence of under-nutrition in pre-school children (NNMB surveys)
Fig 3
YOJANA May 2018 15
51.6 50.9
50 45.6
42.3
ce %

40.9
38.7 38.4
36.5 35.7
Wt for age<-2SD Ht for age <-2SD BMI for age <_2SD
1975-79 1988-90 1996-97 2000-01 2011-12

Fig 3

51.6 50.9
50 45.6
42.3
Prevalence %

40.9
38.7 38.4
36.5 35.7
29.4
30
20.8 20.7 21
18.3
15.1
Stunting under weight Wasting
10
NFHS 1 u-3 NFHS 2 u 3 NFHS 3 u 3 RSOC u-5 NFHS 4 u 5
Survey
Figure 3. Prevalence of under-nutrition in pre-school children (NFHS2, 3, 4 & RSOC)

assessment of nutritional status in standards showed that if BMI for research studies in India indicate
adults. However, WHO standards age is used as the criterion for that under-five children, who gain
for BMI-for-age for children became under-nutrition only 18.4 per cent of undue weight during childhood
available only in 2006 (0-5 years) the under-five children were under- and adolescence, were more prone
and 2007 (5-18 years). Analysis nourished and 2.6 per cent were to become adipose and develop
Fig
of 44 from NFHS 4 using WHO
Figdata over-nourished (Fig 5). Data from hypertension and diabetes in adult
life. At present, there is very little
300
300 awareness on the use of BMI-for-age
for assessment of nutritional status
250
250 in Indian children and providing
births

appropriate nutrition education.


livebirths

200
200
Source ORGI Elimination of blindness
Source ORGI
Rate/1000live

150 IMR
150 IMR D u r i n g t h e 1 9 6 0 s p o v e r t y,
Rate/1000

100 U5MR household food insecurity and hunger


100 U5MR
were widespread among poorer
50 segments of the population. Dietary
50
intake of all nutrients was low and
0 moderate and severe under-nutrition
0
1978

2010
1970
1972
1974
1976

1980
1982
1984
1986
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
2008

2012
2014
2016

in young children were common. Poor


1978

2010
1970
1972
1974
1976

1980
1982
1984
1986
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
2008

2012
2014
2016

Year green and yellow vegetable intake led


Year to widespread vitamin A deficiency.
Fig 5 Figure 4. Time trends in IMR & U5MR Prevalence of respiratory infection and
Fig 5 measles was high in young children
100.0 3.1 2.6 living in overcrowded households.
0.5
100.0 3.1 2.6 The primary health care infrastructure
0.5
80.0 for treating infections was poor in
80.0 58.5
urban areas and non-existent in rural
65.0
% %

60.0 areas. Untreated severe infections,


58.5 79.0
Prevalence

65.0
60.0 especially measles, in the already
79.0
Prevalence

40.0 severely under-nourished young


children, led to keratomalacia; those
40.0
20.0
who survived the infections were often
38.4 34.5 left with nutritional blindness. Studies
20.0 38.4 18.4
34.5 carried out by the National Institute
0.0
18.4 of Nutrition showed that massive
Ht for age Wt for age BMI for age
0.0
Over-nutrition Normal nutrition Under-nutrition dose Vitamin A (200,000 units)
Ht for age Wt for age BMI for age administered once in six months to
Over-nutrition Normalofnutrition
Figure 5. Assessment nutritionalUnder-nutrition
status using BMI in children (NFHS 4) children between one and three years of
Fig 6
Fig 6
16 YOJANA May 2018
Fig 7

age, reduced xerophthalmia by 80 per


cent. Based on these findings, massive
dose vitamin A supplementation
(MDVAS) once every six months for
Low BMIchildren
1-5-year-old (Thin) Feed
wasmore treat infection
initiated
in 1970; but coverage under the
programme was low (<10 per cent).
During the eighties there was a steep
reduction in keratomalacia; over the
Fignext
8 decade blindness due to vitamin
A deficiency was not reported by
major hospitals. Analysis of data
from large-scale studies showed that
the coverage under MDVAS was still
quite low; but the primary health care
infrastructure in urban and rural areas
had been established and access to
immunization, treatment of infections
Universal salt iodization are due to deficiency of iodine in
and severe grades of under-nutrition
water, soil and foodstuffs and affect
had improved substantially. The Iodine deficiency disorders (IDD)
HighofBMI
elimination (Fat) Increase was,
keratomalacia physical activity all socio-economic groups living in
have been recognised as a public defined geographic areas. IDD during
therefore, an example of health care health problem in India since the
pregnancy was associated with high
interventions helping in achieving 1920s. Unlike other micro-nutrient
Fignutritional
9
abortion and foetal wastage rates; some
goals. deficiencies, iodine deficiency disorders infants born to these mothers suffered
from cretinism and mental retardation.
60 55.1
59.3 In adults, IDD include hypothyroidism
50.4 and goitre. Universal use of iodised
45.5 Source: NNMB data salt is a simple, inexpensive method
38.7 1975-79 of preventing iodine deficiency
40
Prevalence %

32.4 1996-97 disorders.


2011-12
I n i t i a l l y, I D D i n I n d i a w a s
thought to be a problem in the sub-
20 Himalayan region. The National
11.8 Goitre Control Programme initiated
4.1 in 1962, focused on supplying
2
iodised salt to those living in goitre
0 belt. Research studies carried out
<18.5 18.5-24.9 >25
BMI men over the next two decades showed
Fig 10
that in areas where iodised salt was
Figure 6. Time trends in over-nutrition in men (NNMB surveys) used there was a decline in cretinism
and mental retardation in children
60
52.4 51.2
and some reduction in the prevalence
47.8 46.4 of goitre in 6-12-year-old children.
44.4 Source: NNMB data
Surveys carried out in the eighties
40 1975-79 showed that IDD existed in pockets
Prevalence %

33.3
in all states in India. Taking this into
1996-97
account National Iodine Deficiency
2011-12
Disorders Control Programme
20 15.5 (NIDDCP) was initiated in 1992
with the goal that all salt for human
6
3.2 consumption will be iodised to
0 ensure universal household access to
<18.5 18.5-24.9 >25 iodised salt. However, over the next
BMI women
fifteen years, the household access
Fig 11 Figure 7. Time trends in over-nutrition in women (NNMB surveys) to adequately iodised salt remained

100.0 YOJANA May 2018 17

80.0
58.1 59.6 55.5
64.7
alence %

60.0
0
<18.5 18.5-24.9 >25
BMI women
Fig 11

100.0

80.0
58.1 59.6 55.5
64.7
Prevalence %

60.0

40.0 3.9
12.8 25.4 31.0
20.0 38.0 increase in the over-nutrition rates
22.5 both in men and in women in the last
15.0 13.5 four decades. The increase in over-
0.0
nutrition rates was steeper between
15-19 yrs 20-29 yrs 30-39 yrs 40-49 yrs
the mid-nineties and 2012 (Figure 6
18.5-24.9 ≥25.0 12.0-18.4 Age of women and Figure 7). Over-nutrition rates
in women were higher than over-
Figure 8. Effect of age on nutritional status in women (NFHS 4))
nutrition rates in men. Data from
below 50 per cent. This was partly also preventing mental retardation NFHS 4 showed that with increasing
because persons living in coastal in children and IDD related health age, over-nutrition rates increased
states with a low prevalence of IDD problems in adults. (Figure 8). Women ignore such weight
were not aware of the health benefits gain and do not seek any nutrition or
of the use of iodised salt and bought Dual nutrition and health burden health advice and incur the risk of
and used cheaper non-iodised salt. Over the last three decades, there NCD and their complications. To
In 2007 mandatory fortification of has been increasing mechanization reduce the health hazards associated
all salt for human consumption with of the transport, occupation and with obesity, it is essential to screen
iodine was notified. Concurrently, household work related activities. men and women for over-nutrition
an awareness campaign on health As a result, there has been a steep and provide appropriate health
benefits of the use of iodised salt reduction in the physical activity and nutrition counselling to over-
was mounted through all media of and majority of Indian have become nourished persons.
communication. These initiatives sedentary. There has been some
paid rich dividends. Data from the Whenever data on time trends
reduction in food intake but this was
NHS 4 showed that in 2015, over 90 in the prevalence of under- and
not commensurate with the reduction
per cent of the households accessed over-nutrition are presented some
in physical activity. As a result, there
and used iodised salt. Universal salt in the audience feel that changes in
has been a progressive rise in over-
iodization programme is an example nutrition. The data from surveys BMI had occurred only in a small
of a nutrition programme not only carried out by the NNMB had shown proportion of women. But overtime
achieving nutritional goals but that there has been a progressive BMI in most women has increased.
As a result, the proportion of women
whose BMI was below the cut-off
for under-nutrition had decreased
and proportion of women whose
BMI was above cut off for over-
nutrition has increased (Figure 9).
For optimal nutrition, those with
BMI <18.5 should gain weight so that
they become normally nourished; but
normally nourished persons should
not gain weight and become over-
nourished. Moderate physical activity
is essential for optimal nutrition and
health. Health education message
(through all media of communication)
that at least 30 minutes of sustainable
discretionary physical activity (such
as walking) per day is essential for

18 YOJANA May 2018


20 health care. Ideally, nutritional
assessment should be carried out
16 periodically in all individuals and
more often in vulnerable segments
Prevalence %

12 of the population such as children,


adolescents, pregnant and lactating
8 women and elderly citizens. Neither
nutrition and health services nor
4 our population, are geared for such
routine periodic assessment for early
0 detection, appropriate counseling and

24.00-24.99
12.00-12.99
13.00-13.99
14.00-14.99
15.00-15.99
16.00-16.99
17.00-17.99
18.00-18.99
19.00-19.99
20.00-20.99
21.00-21.99
22.00-22.99
23.00-23.99

25.00-25.99
26.00-26.99
27.00-27.99
28.00-28.99
29.00-29.99
30.00-30.99
31.00-31.99
32.00-32.99
33.00-33.99
34.00-34.99
35.00-35.99
effective management of nutritional
deficiencies and excesses before
clinical problems arise. Therefore we
BMI frequency distribution women
should begin with an assessment of
NFHS 4 NFHS 3 NFHS 2 nutritional status as when any person
seeks health or nutrition care.
Figure 9. Time trends of Frequency distribution of BMI in women (NFHS 2, 3 & 4)
Once the assessment is done
appropriate advice should be given
optimal nutrition and health may go do not worry about over-nutrition depending upon their nutritional
a long way in halting the rise in over- because it does not interfere with status:
nutrition and NCD rates in adults. their day-to-day life. They do not
l normally nourished persons -
realize that adiposity predisposes
conclusion to NCD. Most of the NCDs are protect their current lifestyles
asymptomatic in the initial phases and provide support for continued
India’s health system was built normal nutrition and health
up with focus on early detection and and so the majority of persons
status;
effective treatment of under-nutrition, with NCD seek care only when
infections and maternal child health symptoms due to complications arise. l those who are under- or over-
problems. Most of these health NCD management requires lifestyle nourished and are at risk of health
problems are symptomatic and acute. modification and lifelong medication. problems - provide counselling
Ill persons do access health care and In the coming years, Indians and regarding appropriate food
under-nutrition and infections can be Indian health system have to reorient intake and physical activity,
readily treated. Over years utilization and gear themselves for successfully if required provide nutritional
of health care had improved and this managing the prevention, early supplementation and monitor for
led to sustained reduction in under- detection and effective management of improvement;
nutrition, ill health and mortality dual nutrition and disease burden. l those with illness- identify
rates. nutritional problems, provide
In the dual nutrition and health
appropriate health and nutrition
In last two decades, over-nutrition burden era, assessment of nutritional
therapy to restore normal health
and associated non-communicable status is an important component
and nutrition and monitor
diseases are emerging as major public of both public health interventions
response.
health problems. Majority of Indians and care of individuals seeking
Nutritionists and physicians have
to play a critical role in combating
the dual nutrition and disease burden
by appropriate nutrition and lifestyle
counselling and nutrition and health
care. Promoting synergy between
health and nutrition services will
enable the country to successfully
face the nutrition challenges and
achieve rapid improvement in
health and nutritional status of the
population. q
(E-mail: premaramachandran@gmail.com,
nutritionfoundationofindia@gmail.com)

YOJANA May 2018 19


YE-747/3/2017

20 YOJANA May 2018


national nutrition strategy
effective monitoring

Accountability for Nutrition Outcomes

Chinmaya Goyal

n th e 7 0 y e a r s s i n c e nutrition status in India an immediate

I independence, India has


made great progress in
all fields, be it economic,
social or political. And yet
priority.
In early years of independence,
the principal challenge was to be self-
sufficient in food production. Due to
there is much more to be achieved.
The Prime Minister has given a clarion the green-revolution, this particular
call towards creating a transformative challenge was largely met. Now,
movement towards “New India” while adequate intake of calories in
by the 75th year of the country’s specific segments of the society does
remain a challenge, there are several
The national nutrition independence, i.e., in 2022.
also other determinants for nutrition
mission is an ambitious One of the most important areas outcomes. These include, for example,
that should be targeted is nutrition. the status of water supply, sanitation,
attempt to create large It is the most basic facets of human and hygiene. It is estimated that the
life. Foundations of long-term illnesses such as chronic diarrhea,
momentum along with economic development are based on often caused due to the lack of proper
innovations in the a well-nourished society. Battling
malnourishment is also one of the
sanitation facilities, is responsible of
about half of cases of malnutrition.
governance mechanisms most effective tools to empower The status of girl child and mothers
people left behind to participate in is also important as their nutritional
for programme the growth process. The economic status influences the status of the
implementation to benefits of investing in proper nutrition child. The Swachh Bharat Mission
are several: improving nutritional (SBM) and the Beti Bachao Beti
credibly tackle the outcomes would help in controlling Padhao missions by the government
diseases, reduce infant and maternal have been launched to tackle these
problem of malnutrition mortality, empower women, break very problems.
the vicious intergenerational cycle
in the country. Now of malnutrition, improve worker In addition, a number of existing
is the time for all productivity, and even improve programs target nutrition outcomes,
learning outcomes for students. An directly or indirectly. These include
stakeholders to combine international study has ascribed the the Integrated Child Development
overall benefits to cost ratio to be 16:1 Services (ICDS), National Health
their energies to make for low and middle-income countries. Mission-, Janani Suraksha Yojana,
the mission a success Therefore the government, which the National Rural Drinking Water
works on the principle of “sabka saath, Programme, Matritva Sahyog Yojana,
sabka vikaas”, has made improving SABLA for adolescent girls, Mid-
The author is an economist and public policy specialist who works in the office of the Vice Chairman, NITI Aayog. In his current
role, he has been involved in producing NITI Aayog’s Three Year Action Agenda, and shaping policy in different areas. He has studied
from the Delhi School of Economics.

YOJANA May 2018 21


Day Meals Scheme, Targeted Public
Distrib u t i o n S y s t e m , N a t i o n a l
Food Security Mission, Mahatma
Gandhi National Rural Employment
Guarantee Scheme and the National
Rural Livelihood Mission among
others.
Given the number of undergoing
schemes, one may ask why there
is need for a specific mission
for nutrition. A national mission
for nutrition is required for four
reasons. First, the current efforts are
fragmented. There is a need to bring
together all the relevant stakeholders
on a single platform to enable a declined marginally from 55.3 per cent The nutrition strategy prepared
synergistic and holistic response to to 53 per cent. by NITI Aayog envisages several
the issue. Second, the mission sets interventions to achieve these targets.
specific targets related to nutritional The national nutrition mission One is to target improvement in
outcomes and a timeline in which aims to accelerate this progress. For nutrition and health during the first
those are to be achieved. This brings example, the decline in stunting in three years in the child’s life. Under-
urgency in tackling the problem of children is aimed at 2 per cent per nutrition during that period creates
malnutrition while demonstrating annum, in comparison to about 1 an irreversible decline in child’s
political commitment towards it. per cent per annum achieved in the cognitive functions, undermining
Third, the mission encompasses a last decade. By 2022 though, a goal their ability to achieve their potential
targeted strategy consisting of a plan of reducing child stunting to 25 per in life. Other interventions are
of actions and interventions. These cent has been laid. The reductions related to nutrition and healthcare
are designed to help accelerate the are targeted for under-nutrition; for mothers, and adolescents, control
improvement in nutritional outcomes. anemia and low birth weights are 2 of micronutrient deficiencies, and
Fourth, the nutrition mission targets per cent, 3 per cent and 2 per cent per community nutrition.
behavioral change through social annum respectively. The programme
awareness, and by creating a mass will cover all states and districts in a Key implementation strategy
movement through a partnership phased manner. The total outlay for
between government, the private the nutrition mission has been set at At a broad level, the core strategy
sector, and the public. over Rs. 9,000 crores for a period of of the national nutrition mission is
three years. creating decentralized governance
These elements would be further
clear on basis of the following
discussion on what the nutrition
mission aims to achieve, and how.

What does the nutrition mission


aim for?
Led by economic growth in the
last 15 years, the nutritional outcomes
have steadily improved. According
to the national family health survey
(NFHS) between 2005-06 to 2015-
16: stunting in children declined
from 48 to 38 per cent, proportion
of underweight children gone down
from 42.5 to 35.7 per cent, proportion
of women with low body mass index
has gone down from 35.5 per cent to
22.9 per cent, and anemia in women

22 YOJANA May 2018


Minister. Another executive committee
of national nutrition mission has been
set up at the secretary level. The design
of these institutions also promotes
cooperative federalism since they
include representation from 5 states
on a rotation basis. One would expect
that the national council will play a
similar role as the GST council has
played in bringing the centre and the
states together to formulate policy in
the area of nutrition. Similarly, states
and districts would be encouraged to
formulate their own nutrition plans.
G e o g r a p h i c a l c o n v e rg e n c e :
Given the widespread disparities in
nutritional outcomes geographically,
it is logical to target districts that have
system with flexibility given to (ICT) driven data collection and been performing the worst. In parallel
states, districts and local level with visualization system. This is based to another flagship programme of the
robust monitoring, accountability on digitization of the manual data government, namely the aspirational
and incentive frameworks that will generated under ICDS, revamping districts programme, attempts would
encourage local solutions. of existing information systems, and be made to uplift the worst-performing
integration of data generated from districts. This will improve aggregate
Outcome orientation: One of the ICDS, national health mission (NHM) outcomes at a faster rate. The national
biggest changes proposed through the and Swachh Bharat Abhiyan. Besides council would also invite district
nutrition strategy is to orient the system providing real-time information, this collectors from 10 worst-performing
towards achievements of outcomes. It will allow tracking and monitoring districts.
will promote accountability at the of individual severely malnourished
ground level. This would be done child. A joint ICDS and NHM mother Jan Andolan: Success in the
through universal monitoring of nutrition mission requires participation
and child protection card will also
parameters of the beneficiaries, and be used for health, maternity and
from communities. This is more so
real-time tracking of the progress because several aspects of changes
nutrition support to the mother and
made. Measurement at the ground are behavioural, and the government
the child.
level allows stakeholders to consider interventions are to ‘nudge’ the
which strategies are working and Monitoring of the outcomes is individual/families/communities
which aren’t, and allows for quick being done through a six-layered towards the right practices. Community
adjustment and scaling up of successful dashboard which shows aggregate based events targeted to improve
strategies across different geographic outcome performance at the level of social awareness on nutrition, and
areas. Furthermore, rankings based on Anganwadi centres, sectors, blocks, nutrition resource centres would be
improvement allows for competition districts, state and national. This will set up for this purpose. Participation
between different villages, districts, be supplemented with a frequent of people in the programme would
independent nutrition survey. be important to develop the required
and states to do better than each other
commitment to bring about lasting
and come out on top. Coordination between different change at the ground level.
Incentives based on outcomes: programmes: The schemes tackling
nutrition were fragmented and were The national nutrition mission is
The strategy envisages that the states,
being run by different departments. an ambitious attempt to create large
districts and panchayats showing
To achieve coordination across these momentum along with innovations
the largest improvement would be
programmes, a national council has in the governance mechanisms for
incentivised. The incentives could be programme implementation to credibly
monetary, or non-monetary, by way of been set up under NITI Aayog with
participation by the ministers from all tackle the problem of malnutrition in
recognition and awards. the country. Now is the time for all
the relevant ministries. This council
Data collection and monitoring: will be responsible for overall policy stakeholders to combine their energies
The bedrock will be an information direction in relation to the nutrition to make the mission a success.  q
and communication technology mission and will report to the Prime (E-mail: chinmaya.goyal@gov.in)

YOJANA May 2018 23


YE-815/2018

24 YOJANA May 2018


nutrition-specific interventions
focus

Nutritional Status in India

Shamika Ravi

lthough India has made Policy-makers must account for

A sizeable economic and


social gains over the
last two decades, the
challenge of maternal
two key facts: (1) direct nutrition
interventions can reduce stunting only
by 20 per cent; indirect interventions
(for example, access to Water and
Sanitation) must tackle the remaining
and  child undernutrition remains
80 per cent, and (2 ) 50 per cent of the
a national public health concern
growth failure of babies accrued by two
and a policy priority for the current
years of age occurs in the womb owing
government. India is home to over 40 to poor nutrition of the mother. A lack
million stunted and 17 million wasted of nutrition in the first 1,000 days of a
children (under-five years). Despite child’s conception causes irreversible
a marked trend of improvement in a damage to a child’s cognitive functions.
variety of anthropometric measures of Hence, there exist significant policy
Given the ever-increasing nutrition over the last 10 years, child returns from investing in this critical
undernutrition rates persist as among stage, that is, from the period of the
weight of the country’s conception of the child to the two-year
the highest in the world. This inequality
economic ambitions, prioritizing is accentuated by stark disparities post-natal period.
nutrition in an integrated health across states. Future improvements
agenda and realigning nutrition Key Nutrition Metrics
in nutritional status of Indian children
policy to target the first 1,000 and mothers will require significant Malnutrition indicators in India
days of a child’s life are crucial investments into human resources remain among the highest in the world,
first steps towards ensuring with critical health investments at the despite a declining trend since the early
India’s development rests on local levels. 1990s. The recent figures from NFHS 4
are more encouraging showing further
steady shoulders. India has  The announcement of the National improvements on most indicators.
made a promising commitment Nutrition Mission (NNM) is a very
in the form of the National significant development on this front. Key Centrally Sponsored Schemes
(CSSs) with a focus on health have
Nutrition Mission which will It has introduced a central nodal agency
seen budgetary cuts over the last two
help us tackle the problem with extensive financial resources to years, with central allocations to the
of malnutrition in children coordinate various central and state ICDS has declined almost 10 per cent
and mothers of the country. government schemes and imbue them from Rs. 15,502 crore (in FY 2015-16)
We need to ensure effective with additional financial resources. to Rs.14,000 crore (in FY 2016-17).
With momentum on the side of the AWCs require investment in vital
implementation of its strategy to
reformers, this brief urges additional infrastructure (close to half of AWCs
achieve our nutrition goals policy reforms to combat malnutrition do not have functional adult weight
in India. scales), and Anganwadi Workers

The author is the Director of Research at Brookings India and Senior Fellow of Governance Studies at Brookings Institution. She
is also Member of the Economic Advisory Council to the Prime Minister of India. Her work focuses on financial inclusion, health,
gender inequality and urbanisation. She is a PhD in Economics from New York University.

YOJANA May 2018 25


Table 1: Nutritional status of children (AWWs) require monitoring to ensure
that they are encouraging target groups
Indicator %*
to avail supplementary nutrition. A
Children (under-five years) who are stunted 38.7 complimentary public intervention is
Children (under-five years) who are wasted 15.1 the provision of school meals as part
of the Mid Day Meal programme.
Children (under-five years) who are underweight 29.4 Field studies highlight the link between
Children (6-59 months) with anaemia1 69.5 the provision of school meals and
improved cognition. Furthermore, the
Source: Rapid Survey on Children (RSoC), 2014;  1National Family Health Survey provision of school meals has been
(NFHS-3), 2006. found to lead to improved learning
Note: *Percentage of relevant population outcomes for children.
It is also worth highlighting that females suffer from malnutrition significantly more than
men. Existing Policy Framework
Table 2: Nutritional status of women and adolescent girls The most prominent government
Indicator %* nutrition interventions include
the ICDS programme led by the
Pregnant women (15-49 years) with anaemia 1 58.7 Ministry of Women and Child
Women (of reproductive age) who are undernourished2 33.3 Development (MWCD),  and the
NHRM led by the Ministry of Health
Women (20-24 years) who were married before the age of 18 3 30.3
and Family Welfare (MHFW). Both
Indian women who are underweight when they begin pregnancy 4 42.2 CSSs prioritise the role of community-
1 2 3 level organisations –AWCs and AWWs
Source:  National Family Health Survey (NFHS-3), 2006;  UNICEF, 2015;  Rapid Survey
under the ICDS and Accredited Social
on Children (RSoC), 2014; 4Coffey, 2014.
Health Activists (ASHAs) under the
Note: *Percentage of relevant population
NHRM – for the delivery of nutrition
interventions to the target groups of
Table 3: Nutrition-specific interventions (ICDS and NRHM[1])
pregnant and lactating mothers, and
Indicator %* infants.
Pregnant women who availed supplementary food under ICDS 40.7 These programmes are
Mothers (of children under-36 months) who received 3+ antenatal check-ups 63.4 supplemented by the PDS, which is
prior to delivery used to provide subsidised food grains
Children (12-23 months) who are fully immunised 65.3 to large sections of the country’s poor.
In addition, more than six states,
Anganwadi Centres (AWCs) without functional adult weight scales 48.4 including Maharashtra,  Madhya
Source: Rapid Survey on Children (RSoC), 2014. Pradesh, Uttar Pradesh, Odisha,
Note: *Percentage of relevant population Gujarat, Karnataka, and most recently

26 YOJANA May 2018


Jharkhand have also established state
nutrition missions. An overview of
the interventions directly relevant to
the first 1,000 days of a child’s life is
provided in Table 5.
The National Nutrition Mission
(NNM) has been set up with a
three year budget of Rs.9046.17
crore commencing from 2017-18.
The NNM will comprise mapping
of various Schemes contributing
towards addressing malnutrition,
including a very robust convergence
mechanism, ICT based Real Time
Monitoring system, incentivizing
States/UTs for meeting the targets,
incentivizing Anganwadi Workers
(AWWs) for using IT-based tools,
eliminating registers used by AWWs,
introducing measurement of height key lessons for nutrition-specific policy 2. E x t e n d c o v e r a g e o f f o o d
interventions are as follows: fortification of staples
of children at the Anganwadi Centres
(AWCs), Social Audits, setting-up 1. Strengthen and restructure ICDS, Currently, fortification of staples is
Nutrition Resource Centres, involving and leverage PDS limited to the mandatory iodisation of
masses through Jan Andolan for their salt. However, the Food Safety and
participation on nutrition through ICDS needs to be in mission Standards Authority of India (FSSAI)
various activities, among others. It mode, with a sanction of adequate is in the process of formulating draft
will be a central nodal agency that financial resources (from the central standards for the fortification of food
helps coordinate central and state government) and decision-making grains which will add to the nutrient
government programmes  and  infuse authority. Last-mile delivery of ICDS value. Additional proposals under
them with additional funds/resources interventions needs to standardise the consideration include making the
nutritional component of supplementary double fortification of salt (with iodine
Policy Recommendations food,  prioritise  educational outreach and iron), and the fortification of
to pregnant and lactating mothers, edible oils mandatory. The standards
In response to the persistence improve programme targeting, and of the hot cooked meal should also be
of the undernutrition challenge in streamline operations of AWCs through changed to using only fortified inputs.
India, and taking note of the evidence better infrastructure provision and This would help in providing sufficient
evaluating current policy approaches, training for AWWs. calories and micronutrients to a large
number of children under-five.
Significant state-level disparities in nutritional status and
progress on reducing stunting 3. Target multiple contributing
Table 4: State-level disparities in nutritional status factors, for example, WASH

Indicator India Avg.* Best Performers Worst Performers The underlying drivers for India’s
‘hidden hunger’ challenges are complex
Children (under-five) 38.7% Kerala: 19.4% Uttar Pradesh: and go beyond direct nutritional inputs.
who are stunted Goa: 21.3% 50.4% The significant push by the present
  Tamil Nadu: 23.3% Bihar: 49.4% government since 2014 on sanitation
Jharkhand: 47.4% under the Swachh Bharat Abhiyan has
Children (under-five) 15.1% Sikkim: 5.1% Andhra Pradesh: increased access to toilets throughout
who are wasted Manipur: 7.1% 19.0% the country. However, the push for toilet
Jammu & Kashmir: 7.1% Tamil Nadu: 19.0% construction must be combined with a
Gujarat: 18.7% strategy for behavioural change.
Children (under-five) 29.4% Manipur: 14.1% Jharkhand: 42.1%
4. Align agricultural policy with
who are underweight Mizoram: 14.8% Bihar: 37.1%
national nutritional objectives
Jammu & Kashmir: 15.6% Madhya Pradesh:
36.1% Agriculture policy must be brought
Source: Rapid Survey on Children (RSoC), 2014. in tune with nutrition policy, with
Note: *Percentage of relevant population incentives provided for encouraging

YOJANA May 2018 27


Table 5: Nutrition-specific interventions the production of nutrient-rich and local
(relevant to the first 1,000 days of a child’s life) crops for self-consumption. Efforts
should also be made to reduce current
Target Group Schemes Key Interventions
distortions in agricultural incentives
Pregnant and ICDS ICDS: Supplementary and to discourage the cultivation
Lactating nutrition, counselling on diet, rest and of resource-rich cash crops with no
Mothers breastfeeding, health and nutrition nutrient value, such as sugarcane and
education cotton. Agriculture should be focused
  Indira Gandhi Conditional Maternity Benefit on securing diet quality for infants and
Matritva Sahyog young children.
Yojana (IGMSY)
5. Boost private sector engagement
  Reproductive NRHM: Antenatal care, counselling, in nutrition interventions
Child Health iron supplementation, immunisation,
(RCH-II), transportation for institutional delivery, Private sector collaboration in the
National Rural institutional delivery, cash benefit, post- form of public-private partnerships
Health Mission natal care, counselling for breastfeeding (PPPs) has the potential to leverage the
(NRHM), Janani and spacing of children etc. appropriate technology for scaling-up
Suraksha Yojana food fortification interventions and to
(JSY) develop and distribute nutrient-rich
Children ICDS ICDS: Supplementary nutrition, growth foods to improve maternal and infant
(0-3 years) monitoring, counselling health education nutrition. The government should
  of mothers on child care, promotion of facilitate PPPs in the sector that can
infant and young child feeding, home- leverage technological solutions for
based counselling for early childhood scaling up food fortification initiatives
stimulation, referral and follow-up of and complement the government’s
undernourished and sick children outreach efforts through mass
  RCH-II, NRHM: Home-based newborn care, im- awareness.
NRHM munisation, micronutrient supplemen-
  tation, deworming, health check-up,
Conclusion
  management of childhood illness and Ahealthy population is a precondition
severe undernutrition, referral and cashless for sustainable development, and
treatment for the first month of life, care of India faces significant challenges in
sick newborns, facility-based management harnessing long-term dividends from
of severe acute malnutrition and follow-up
its young population. The success of the
  Rajiv Gandhi Rajiv Gandhi National Creche Scheme: government’s numerous programmes
National Creche Support for the care of children of working is dependent on the availability of
Scheme  mothers a trained workforce. India has the
world’s highest number of children
at risk of poor development: as of
2010, 52 per cent of the country’s 121
million children (under-five) were at
risk. Given the ever-increasing weight
of the country’s economic ambitions,
prioritizing nutrition in an integrated
health agenda and realigning nutrition
policy to target the first 1,000 days
of a child’s life are crucial first steps
towards ensuring India’s development
rests on steady shoulders. India has
made a promising commitment in the
form of the National Nutrition Mission
which will help us tackle the problem
of malnutrition in children and mothers
of the country. We need to ensure
effective implementation of its strategy
to achieve our nutrition goals.  q
(E-mail: sravi@brookingsindia.org)

28 YOJANA May 2018


YE-732/6/2017

YOJANA May 2018 29


economic empowerment
roadmap

Financial Inclusion in India:


Challenges and Way Forward
Charan Singh

inancial inclusion is financial inclusion. The Cooperative

F a process that enables


improved and better
sustainable economic and
social development of
the country. It focuses on raising the
Credit Societies Act, 1904 gave an
impetus to cooperative movement in
India. The objective of cooperative
banks was to extend banking facilities,
mainly availability of credit on easy
standard of living of the underprivileged terms compared to money lenders
people in the society with the objective
who were well known to charge high
of making them self-sufficient and
well informed to make better financial rates of interest. In India, financial
In view of the success inclusion exercise explicitly started
decisions. Also, it acknowledges the
of PMJDY, a new gap participation of the low-income groups with the nationalization of State Bank
clearly emerged and that based on the extent of their access of India in 1955.   In 1967, there
to financial services in economic emerged a debate on social banking
is regulation of the micro
growth. and consequently, 14 private sector
and rural sector. The RBI, banks were nationalised in 1969 to
set up in 1934 regulates The Committee on Financial
Inclusion (Government of India,
serve the unbanked population, mainly
weaker sections of society as well as
and supervises the banking 2008) defined financial inclusion as the
process of ensuring access to financial rural areas. The concept of priority
system.  In addition, though sector lending became important by
services and timely and adequate credit
financial inclusion has been where needed by vulnerable groups at 1974 which implied directed lending
pursued by commercial an affordable cost. The aim of financial to unbanked areas, and in 1980, eight
inclusion is delivery of financial more private banks were nationalized
banks for many decades, services to low-income groups with to extend banking in rural and remote
the focused approach has the provision of equal opportunities. areas. Since then, there has been a
been missing. It may now The Committee suggested that financial considerable reorientation of bank
inclusion must be taken up in a mission lending to accelerate the process of
be necessary to assign the mode to achieve universal financial development, especially of the priority
regulation and supervision inclusion within a specific time frame sector, which had not previously
of financial inclusion to and constitution of two dedicated
funds focused on development and
received sufficient attention.
NABARD, with experience technology for better credit absorption Since 2005,  Government of India
of more than four decades, by poor. along with the Reserve Bank of
India (RBI) and National Bank for
with clear accountability Historical Developments
Agriculture and Rural Development
and responsibility In fact, contrary to general belief, (NABARD) has been initiating a
historically, India is a pioneer in number of concerted measures to
The author is visiting Professor at UCLA Anderson, Los Angeles, USA. Earlier, he was the RBI Chair Professor of Economics at Indian
Institute of Management, Bengaluru. Dr. Singh did his post-doctorate studies from Harvard and Stanford Universities, after completing his
PhD in Economics from University of New South Wales, Sydney. He had earlier worked in Punjab National Bank, Reserve Bank of India
and International Monetary Fund before joining the academia in December 2012.

30 YOJANA May 2018


enhance financial inclusion in India. groups.  The Government continued total amount of bank deposits with
These measures include Self Help its efforts towards achieving financial commercial banks was Rs. 79,012.1
Group-bank linkage programme, inclusion by introducing Micro Units crore as on April 10, 2018.
use of business facilitators and Development Refinance Agency
(MUDRA) to focus on providing Challenges
correspondents, easing of ‘Know-
Your-Customer ’ (KYC) norms, credit to small entrepreneurs. Similarly, The key challenges in extensively
electronic benefits transfer, use of having successfully achieved the extending financial inclusion are-
mobile technology, opening ‘no-frill distinction of ensuring that more than
1. Some Accounts under PMJDY are
accounts’ and emphasis on financial 95 percent of Indian households have not operative–In some cases, bank
literacy.  Other measures initiated by bank accounts through the PMJDY by accounts are not operative due to
the Government to support financial 2015, in a logical and well-sequenced lack of funds with account holders.
inclusion include opening customer step, the Central government extended The cost-effectiveness aspect,
service centres, credit counselling social security to the masses. The given low balances in accounts,
centers, Kisan Credit Card, National flagship scheme, Atal Pension Yojana in implementing technological
Pension Scheme-Like, Mahatma (APY) aims to provide old age income advancements is a matter of
Gandhi National Rural Employment security to the working poor in the concern.
unorganized sector; Jeevan Jyothi
Guarantee Scheme and Aadhaar 2. Lack of financial literacy - The rural
insurance scheme providing a one year households do not have adequate
scheme. The banking penetration,
cover, renewable annually, offering financial literacy resulting in lack
despite concerted efforts, was low.
life insurance; and Suraksha insurance of awareness of many financial
In this context, to ensure a banking scheme, renewable annually, providing services provided by financial
account in every household, the Prime insurance to cover death or disability institutions.
Minister, in his maiden speech from on account of an accident.
3. Too large volumes of Accounts–
the Red Fort on August 15, 2014, The PMJDY has made significant There is a need for technical and
announced the need for focused progress since its launch and as on institutional infrastructure for
efforts. The objective of Pradhan April 10, 2018, a total of 31.4 crore e-payment systems to service a
Mantri Jan Dhan Yojana (PMJDY) accounts had been opened of which large number of new and existing
was widening access to various basic 18.5 crores were in rural areas, 12.9 accounts.
financial services like basic savings crores in urban areas and 16.6 crores 4. Need for Manpower planning–
bank account, need-based credit, were female account holders.   The There is a requirement of sufficient
remittances facility, and insurance and number of Rupay cards have also technical skill development and
pension to excluded sections, mainly increased to 23.7 crores.  The progress training for banks and institutional
weaker sections and low-income has been impressive, considering that staff.

YOJANA May 2018 31


In India, the scenario for the next
few decades may have to take into
account the following –
a) Indian economy is closely
associated with agriculture and
rural activities because nearly
66 percent of the population still
resides in rural areas. 
b) India accounts for 16 percent of
world population and only 4 per
cent of water resources.  The critical
shortage of water would become
apparent for the agriculture sector
especially with rising population. 
5. Secure Environment - The security know-your-customer norms have c) The scarcity of land, because
of electronic transactions is a matter been diluted. of rising population as well as
of concern especially with a large increasing urbanization and
number of new accounts, in remote Road Ahead industrialization would imply
parts of India. a higher cost of producing
In the last two decades, substantial
6. Ease of transaction- Lack of ease food grains and agricultural
changes have taken place in the banking
production.   
in transaction related activities in and financial industry, in India and
banks is clearly demonstrated by abroad.  The commercial viability of d) As on March 31, 2014, there was
the repetitive behavior of rural financial inclusion has been established 123 crore deposit accounts.   In
households’ persistence in taking and the governments, globally, have addition, Post Offices held 28
loans from the money lenders. been making efforts to extend financial crore accounts. PMJDY has
7.  Need for greater use of technology - services to large segments of the resulted in creating nearly 31
On the operational side, despite population because financial inclusion crore new accounts in banks.  In
the convenience offered by ATMs promotes economic equality and addition, the Prime Minister has
in providing banking services, the economic growth.   Formal financial announced social security schemes
debit card penetration continued institutions provide low-cost access to which will operate through the
to be low with only 30 per cent of banking facilities, safeguarding funds banking system.  Further MUDRA
deposit account holders having a and providing a convenient accounting bank will also encourage banking
debit card. in addition to rewarding depositors activity at the lower end of the
with interest payment.   Banks economic spectrum. 
8. Demand Side Factor -Factors such
as lower income or asset holdings, intermediate between savers and e) The new accounts under Jan Dhan
lack of awareness about the financial investors and thereby provide resources as well as other schemes that
products, perceivably unaffordable for growth.   Therefore, people may have recently been announced
products, high transaction costs, not have savings to place as deposits would result in  massive banking
products which are not convenient, but may have a need for resources operations and expectations of
inflexible, and not customized to which can be used for generating banking services at places which
the rural sector income pattern are employment as well as stirring activity do not have bank branches.
a major barrier for gaining access in the economy.  This would imply a higher cost
to the financial system.
9. Costs and risks in using technology-
Costs in terms of increasing
expenditure on IT deployment and
risks in terms of monetary loss,
data theft and breach of privacy are
a concern. Thus, banks need to be
extremely cognizant of such risks.
10. Cyber Security-Nearly 31 crore
new accounts have been opened
in previous 3 years under PMJDY
and nearly 80 percent of these are
first time users. This can be a threat
to cyber security especially when

32 YOJANA May 2018


of serving at remote places by has a low level of literacy of about 70 helpful if a long-term plan with cost
commercial banks.  per cent, with English literacy of not implications and a stipulated timeline
f) The government has announced more than 10 per cent of the population. is prepared to decide on various aspects
that it would directly transfer Given the fact that all electronic of building a digital economy.   To
resources to the people using devices have English numerals and rapidly digitalize India, probably, there
technology as well as bank all communication on digital banking is a need for a Committee to understand
accounts.   The direct benefit is also in English, there is the natural the problem, become aware of the
transfers would imply additional barrier to completely digitalize Indian challenges, and then prepare a roadmap
financial resources to the public, economy during the immediate period. to achieve success.  As the government
generally low-income group. The India continues to have 30 per cent of has addressed the issue of smart cities
higher food prices are also leading its population or nearly 40 crore people by announcing a list of select 100 cities
to increase in purchasing power below the poverty line and 90 percent where technological amenities would
of rural areas. The PM has also operating in the informal sector. These be provided in a phased manner, a
promised to double of farmer’s people could also be slow in embracing similar strategy, pilot based projects,
income by 2022. The proportion of digital economy. In addition, low and operations, could be adopted for
the population that would emerge volume of business in rural shops, digitalization.  
out of poverty would need to be shopping sheds, rural makeshift kiosks
estimated.  may not justify the cost of installing In view of the success of PMJDY,
equipment to read and safely secure a new gap clearly emerged and that is
Conclusion and Recommendations the data on plastic money. The cost of regulation of the micro and rural sector.
providing equipment in remote parts The RBI, set up in 1934 regulates and
The objective of financial inclusion
of the country and ensuring seamless supervises the banking system.   In
is to provide financial resources to
the consumers at affordable rates.  In
connectivity at the affordable cost addition, though financial inclusion
would be another challenge that would has been pursued by commercial
view of the increasing complexity of
need to be addressed.   The use of banks for many decades, the focused
financial inclusion, there may be a
e-money, at present, is largely restricted approach has been missing. It may now
need to consider a roadmap as well as
to urban areas, and more educated be necessary to assign the regulation
a regulator.
youth from rural areas. Even if there and supervision of financial inclusion
The issue of digitization, necessary are smartphones in the rural areas, these to NABARD, with experience of
for achieving higher financial inclusion, are restricted to only one member of more than four decades, with clear
is serious and needs analysis. India is the family which implies that banking accountability and responsibility.  q
a very diverse country in terms of activities, private in nature, would
languages and scripts. Also, the country be restricted. Therefore, it may be (E-mail: Charan.singh@anderson.ucla.edu)

Baseline Ranking of Aspirational Districts


The NITI Aayog launched the baseline ranking for the Aspirational Districts recently. These ranking are to be based
on published data of 49 indicators (81 data points) across five developmental areas of Health and Nutrition, Education,
Agriculture and Water Resources, Financial Inclusion and Skill Development, and Basic Infrastructure. The ranking
was released by Shri Amitabh Kant, CEO of NITI Aayog. The ‘Champions of Change’ Dashboard for real-time data
collection and monitoring was open for public viewing from April 1. The dashboard facilitates District Collectors of
all the aspirational districts to input the latest available data of their respective districts. Districts can learn from each
other's experiences using the "Best Practices" document that NITI Aayog has prepared and circulated to the district
collectors.
Launched by the Prime Minister in January, the ‘Transformation of Aspirational Districts’ programme aims to quickly
and effectively transform some of the most underdeveloped districts of the country.The broad contours of the programme
are Convergence (of Central and State Schemes), Collaboration (of Central, State level ‘Prabhari’ Officers and District
Collectors), and Competition among districts driven by a Mass Movement or a Jan Andolan. With States as the main
drivers, this program will focus on the strength of each district, identify low-hanging fruits for immediate improvement,
measure progress, and rank districts.
To enable optimum utilization of their potential, this program focusses closely on improving people’s ability to participate
fully in the burgeoning economy. Health and Nutrition, Education, Agriculture and Water Resources, Financial Inclusion
and Skill Development, and Basic Infrastructure are this programme’s core areas of focus.After several rounds of
consultations with various stakeholders, 49 key performance indicators have been chosen to measure progress of the
districts. Districts are prodded and encouraged to first catch-up with the best district within their state, and subsequently
aspire to become one of the best in the country, by competing with, and learning from others in the spirit of competitive
and cooperative federalism.

YOJANA May 2018 33


YE-786/3/2017

34 YOJANA May 2018


growth drivers
fast track initiatives

Boosting Infrastructure to fuel Development

Hiranmoy Roy

he Government has cities have been approved. Water

T announced commitments
to build large infrastructure
projects through significant
public expenditure and
with the help of private partners –
supply contracts for 494 projects
worth Rs.19,428  crore  and sewerage
work contract for 272 projects costing
Rs.12,429  crore  have been awarded.
The government also ensured to
including foreign investors. There are leverage the India Infrastructure
some areas in infrastructure where Finance Corporation Limited (IIFCL)
the externalities caused by projects to help finance major infrastructure
cannot be captured by project revenues projects, including investments in
The growth drivers for alone.   Therefore, the Government education and health infrastructure,
infrastructure in India are has created a Viability Gap Funding on strategic and larger societal benefit
arrangement through a window in the considerations.
Government Initiatives, Finance Ministry.
Infrastructure Need, The government has scaled new
 Urbanization is an opportunity and heights in development of Road
Housing Development, priority so the government has rolled out Infrastructure sector.  It is confident to
International Investment, two inter-linked programmes – Smart complete National Highways exceeding
Cities Mission and the AMRUT.  Smart 9000 kilometers length during 2017-
and Public-Private Cities Mission aims at building 100 18.  Ambitious BharatmalaPariyojana
Partnerships.... Smart Cities with state-of-the-art has have been approved for providing
Infrastructure provision amenities. 99 Cities have been selected seamless connectivity of interior and
with an outlay of 2.04 lakh crore. backward areas and borders of the
in Union Budget 2018-19 These Cities have started implementing country to develop about 35000 km in
is supposed to increase various projects like Smart Command Phase-I at an estimated cost of Rs.5.35
and Control Centre, Smart Roads, lakh crore.
GDP growth, strengthen Solar Rooftops, Intelligent Transport
connectivity, especially Systems, Smart Parks. Projects worth Power Sector
the border areas that are Rs. 2350 crore have been completed
and works of Rs. 20,852 crore are under In the power sector the government
strategic to be connected progress. To preserve and revitalize is working towards changing the law
soul of the heritage cities in India, so that power purchase agrements
to the mainland, boost (PPAs) are enforced. The PPAs would
National Heritage City Development
health services, education, and Augmentation Yojana (HRIDAY) seek to cover 100 per cent of the anual
agriculture, transportation, has been taken up in a major way. average demand of a particular state or
The AMRUT programme focuses a discom. The government’s strategy is
tourism and overall aimed at improving India’s per capita
on providing water supply to all
infrastructure sector households in 500 cities. State level power consumption, which is around
plans of Rs.77,640  crore  for 500 1000 kWh among the lowest in the

The author is an Associate Professor in the Department of Economics, School of Business (SoB), University of Petroleum and Energy
Studies (UPES), Dehra Dun having 17 years of teaching and research experience. He has completed several research and consultancy
projects of NITI Aayog, UGC and World Bank.

YOJANA May 2018 35


world. In comparison, China has a per (IHSDP) components later Rajiv Transport
capita consumption of around 4,000 AwasYojana (RAY) of JNNURM. The
kWh, with developed nations averaging biggest challenge that this program In the transport sector, the framing
around 15,000kWh per capita.   The faced was the scarcity of suitable land, of an integrated transport  policy  to
which the Planning Commission of fasten the development of infrastructure
government also talked about a radical
for the sector is recommended by a
plan to separate the so-called carriage India (2012–2017) attributes to the
study of GoI. The objective of the study
and content operations of existing suboptimal land-use patterns, largely
was primarily to look into the projected
power distribution companies. Carriage induced by the regulatory regime in
traffic flow, freight transport and the
refers to the distribution aspect and place, the lack of long-term urban
investment required for the development
content to electricity itself. In industry planning, and the lack of a participatory
of infrastructure in transport sector
parlance, these are known as “wire” planning process to determine the most during the next two decades. The
and “supply”. The separation will efficient use of parcels of land. Delays major findings of the study suggested
allow people and companies in India in implementing such programs led to a transport system must cut across
buy electricity from a power company cost escalations, which, in turn, meant modes of transport, administrative
of their choice, and have it supplied to housing was not delivered on the geographies, and integrate capital
them by the distribution network that required scale and became unaffordable investment with regulatory and policy
services the neighborhood in which to the target demographic. Projects for development.
they live. The result, apart from the funded under the Urban Infrastructure
choice for consumers, would be lower and Governance (UIG) submission Some of the specific actions taken by
tariffs because of the competition. This required the possible eviction of Government include the development
will help in reduction of cross-subsidies slum dwellers, in which case clear of inland waterways, coastal shipping,
borne by the industry, and make tariffs policies on their rehabilitation were dedicated freight corridors in railways,
necessary. The RAY program had a electronic tolling system, development
more competitive for businesses
short implementation span before a of public transport including metro,
thereby pushing the government’s
new program, Housing for All (Urban) bus rapid common ticketing for
‘Make in India’ drive. With an eye
Mission, which was launched in 2015, urban transport etc. The policy had
on better targeting of subsidies, the stated that it is necessary to create a
government is also exploring the use of replaced it. According to the Ministry of
Housing and Urban Poverty Alleviation policy environment that encourages
direct benefits transfer (DBT) scheme competitive pricing and coordination
(MHUPA) summary statement on the
in the electricity sector. Government’s between alternative modes in order to
RAY, between 2013 and 2015, 117,707
policy think-tank NITI Aayog has provide an integrated transport system
houses were sanctioned and only 3,378
pitched for DBT in the electricity sector that assures the mobility of goods and
were completed (MHUPA 2015).
with its draft national energy policy. people at maximum efficiency and
The Housing for All Mission aims to
build on RAY and fully address the minimum cost.
Housing
housing shortage by 2022. However, Union Budget 2018 is a game
In the field of housing, Low Income the initial budget allocation by the changer for infrastructure sector as the
Group (LIG) housing was provided central government for the program government of India is taking a lot of
through Basic Services for Urban for 2015–2016 is Rs.40 billion, which initiatives in the field of infrastructure.
Poor (BSUP) and Integrated Housing is too small to have any major impact Due to the strategic importance of this
and Slum Development Programme (MHUPA 2015). sector, an in-depth analysis is needed to
evaluate the opportunities and growth
drivers of infrastructure development
in India of new initiatives taken in
Union Budget 2018.
Recent trend and pattern of Indian
infrastructure sector are characterized
by the high budgetary allocation for
the sector, rising infrastructure deals,
increasing private sector investment,
improvement in logistics and raising
FDI in the sector.
The strong advantages of
infrastructure development in India
are governed by huge demand as it
has a requirement of investment worth
Rs.50 trillion (US$ 777.73 billion)
in infrastructure by 2022 to have

36 YOJANA May 2018


sustainable development in the country.
Sectors like power transmission, roads
and highways and renewable energy
will drive the investments in the
coming years.  Attractive opportunities
in India such as favorable valuation and
earnings, the Regional Connectivity
Scheme and immense scope for
improvement as only 24 percent of
the National Highways are four lanes.
The competitive advantages such as
attracting the major global players
like China Harbour Engineering and
Mizuho Financial Group and the sector
received huge FDI inflows in 2017.
Interestingly strong policy support
like the one ‘Housing for All’ and
‘Smart Cities Mission’ the Government
of India is working on reducing cement  and  electricity. The overall Public Private Partnership
bottlenecks pushing growth in the index grew by 4.8 per cent during FY
infrastructure sector.   With the UDAY 2016-17. Electricity (10  per cent), The opportunities in infrastructure
Scheme, that will help in financial steel (9  per cent), refinery products sector are broadly coming through
turnaround and revival of electricity (8.9 per cent), cement (5.8 per cent) and Government Initiatives, International
distribution companies of India, the fertilizers (3.3 per cent) led the growth Associations  and  Urban Indian Real
power sector has been registering in the index.  The cumulative growth of Estate. The Government is attempting to
strong growth. Also 100 per cent the index between April-October 2017 revive and give a boost to Public-Private
FDI is permitted under the various was 3.5 per cent. Partnerships. To make India a global
infrastructure sectors. hub for electronics manufacturing, a
The growth drivers for infrastructure provision of the total allocation for
A strong momentum is also over in India are Government Initiatives, infrastructure in Budget of 2017-18
served in the expansion of roadways. Infrastructure Need, Housing stands at US$ 61.48 billion. Japanese
Value of total roads and bridges Development, International Investment, investment has played a significant
infrastructure in India is estimated to and Public-Private Partnerships. The role in India’s growth story. Japan
have expanded at a CAGR of 13.6 total allocation for infrastructure in has pledged investments of around
per cent over FY09–17 to US$ 19.2 Budget of 2017-18 stands at US$ 61.48 US$35 billion for the period of 2014-
billion. billion and major sectors covered are 19 to boost India’s manufacturing and
Railways and Metro Rail, Construction, infrastructure sectors. The Japanese
The eight core infrastructure government is constantly looking for
industries include coal, crude oil, natural Telecom and Energy, Roads and
Airport. investment opportunities in India.
gas, refinery products, fertilizers, steel, Asian Development Bank will provide
Table 1: Summary of Infrastructure Projects Completed During the US$ 275 million loans for a piped
12th Five-Year Plan water supply project for rapidly
urbanizing small towns, covering 3
Sector  Number of Projects Cumulative Expenditure lakh households, in Madhya Pradesh.
(US$)  India will need to construct 43,000
Road Transport and Highways 91 8.7 billion houses every day until 2022 to achieve
Power 73 16.63 billion the vision of Housing for All by 2022.
Petroleum 65 19.48 billion Hundreds of new cities need to be
Railways 33 3.81 billion developed over the next decade under
Steel 20 8.13 billion the smart city programme. This has the
Shipping and Ports 20 1.78 billion potential for catapulting India to third
largest construction market globally.
Telecommunications 14 463.62 million
The sector is expected to contribute
Coal 9  2.26 billion
15 per cent to the Indian economy by
Fertilizers 6 596.24 million 2030. The recent policy reforms such as
Civil Aviation 5 861.16 million the Real Estate Act, GST, REITs, steps
Urban Development 5 678.83 million to reduce approval delays etc. are only
Atomic Energy  1 168.93 million going to strengthen the real estate and
Source: Ministry of Statistics and Programme Implementation (MoSPI) construction sector. 

YOJANA May 2018 37


Capital Outlay on Infrastructure Sector: Union Budget 2018 be needed for Sagarmala until 2035.
The Govt. is confident of completing
  RE 2017-18 BE 2018-19  Per
National Highways exceeding 9000
(Crore) (Crore) Change km length during 2017-18, Jaitley
1  Ministry of Coal 14478 15799 9.124188 said. The country has a road network
2 Ministry of Development of North 330 600 81.81818
of 3.3 million km, the second largest
globally.
Eastern Region (for infra.)
3 Ministry of New  9466 10317 8.99007 Plan outlay for Indian Railways
and Renewable Energy in next fiscal has been pegged at
4 Ministry of Petroleum  87319 89210 2.165623
1.48 lakh crore, highest ever outlay
for national transporter. Track
and Natural Gas renewal of 3,999 km, procurement
5 Ministry of Power 64318 53469 -16.8678 of 12,000 wagons, safety fund of
6 Ministry of Civil Aviation 2543 4086 60.67637 Rs.20, 000  crore, and electrification
7 Department of  9786 16986 73.57449 of 6,000 km planned. The national
Telecommunication transporter will raise 28,500 crore from
8 Ministry of Railways 80000 93440 16.8 extra-budgetary support from extra-
9 Ministry of Housing  15193 39937 162.8645 budgetary resources such as IRFC
bond and 26,440  crore  through other
And Urban Affairs borrowings. Vinayak Chatterjee,
10 Ministry of Road  59279 62000 4.590158 Chairman of Feedback Infra, an
Transport and Highways integrated infrastructure company,
11 Ministry of Shipping 3165 4042 27.70932 said that Railways capital expenditure
12 Ministry of Steel 11428 11294 -1.17256 plan lays focus on electrification,
  Grand Total 357305 401180 12.27943 safety  and  modernization. Passenger
safety and amenities are the prime
Source: Union Budget 2018.
focus and raising non-fare revenue to
Recent Budget Provisions 8 per litre road and infrastructure cess boost efficiency.
on imported petrol and  diesel. The Budgetary allocation for
The Govt. has set aside Rs. 21,000 government and market regulators
crore for building 5.1 million rural Ministry of Housing and Ministry of
also have taken necessary measures for Development of North Eastern Region
houses in FY 19 apart from the 5.1 development of monetizing vehicles
million being constructed this year (for infrastructure) has the highest
like infrastructure Investment Trust increase in 2018-19 as compared to
under the Prime Minister AwasYojana
(InvIT) and Real Investment Trust 2017-18 and an overall increase in
(PMAY). Sectors including cement,
(ReITS). The Govt. would initiate allocation for infrastructure sector is
steel, paints, sanitary ware and
monetizing select Central Public Sector 12.27 per cent.
electricals could benefit from the
Enterprises (CPSE) assets using InvITs
Government’s decision to step up its Thus, the Union Budget 2018 has
affordable housing drive. The Govt. from next year.
identified infrastructure sector as the
will create a dedicated Affordable As a part of new integrated growth drivers of Indian economy
Housing Fund in National Housing infrastructure planning model the and essential for further economic
Bank. An interest subsidy will be NDA government unveiled the largest development. Infrastructure provision
provided to rural households that are – ever rail and road budget of Rs. in Union Budget 2018-19 is supposed
not covered under PMAY. 1.48 lakh crore and 1.21 lakh crore, to increase GDP growth, strengthen
India will invest as much as Rs. 5.95 respectively in 2018-19. India needs connectivity, especially the border
lakh crore in creating and upgrading to fund  for  ambitious plans such as areas that are strategic to be connected
infrastructure in the next financial Sagarmala (ports) and Bharatmala to to the mainland, boost health services,
year, said  the Finance Minister. He improve its transport infrastructure education, agriculture, transportation,
said, “Our country needs massive through raising equity from the market. tourism and overall infrastructure
investments estimated to be in excess To raise equity from the market for its sector. The Finance Minister also
of Rs. 50 lakh crore in infrastructure to mature road assets, NHAI will consider mentioned smart cities mission
increase the growth of GDP, connect organizing its road assets in to Special to provide smart solutions to the
and integrate nation with a network Purpose Vehicle (SPV) and innovating technological and digital problems of
of roads, airports, railways, ports and monetizing structure like Toll Operate urban India, AMRUT to provide basic
inland  waterways  to provide good and Transfer (TOT) and InvIT. The total services to urban India and HRIDAY to
quality services to our people”. To investment estimated for Bharatmala is protect heritage cities and to promote
raise resources,  state-owned  firms Rs. 10 lakh crore – the largest outlay tourism and sustainable development
would access the equity and bond for a Govt. road construction scheme of heritage sites.  q
markets. The budget also levied a Rs. – an additional Rs. 8 lakh crore will (E-mail: h.roy10@gmail.com

38 YOJANA May 2018


YE-819/2018

YOJANA May 2018 39


Social Inclusion
Measures

Stretching a Hand to the Vulnerable

V Srinivas

ocial Inclusion refers Article 15 (3) empowers the State

S to access to favourable
opportunities in society to
enhance one’s life chances.
Such opportunities
comprise of education, employment,
to make special provisions for women
and children in educational institutions
and employment opportunities. This
provision has been widely invoked by
Government for providing exclusive
social services and social protection. reservation of certain categories of
The absence of these opportunities posts for women and for reservation of
is social exclusion, which results in women in local bodies and educational
marginalization, poverty and material institutions. Article 15 (4) seeks to
India’s Social Inclusion deprivation. This article deals with promote the educational advancement
programmes are comprehensive the programmes and policies of the of socially and educationally backward
and their implementation government towards improving the classes of citizens, i.e. the OBCs,
lives of the vulnerable like the girl the Scheduled Castes and Scheduled
supervised by a number Tribes in matters of admission of
child, women, weaker sections and
of independent Ministries students belonging to these categories
elderly.
with adequate resource in unaided educational institutions.
allocations. Not only have Constitutional Provisions Article 17 abolishes untouchability
statutory legal provisions and its practice in any form. The
The Constitution of India through enforcement of any disability arising
been enacted, autonomous its Preamble seeks to secure to all its out of untouchability shall be an
National Commissions have citizens- justice, social, economic and offence in accordance with the law.
been established to protect the political; liberty of thought, expression,
belief, faith and worship; and equality The Directive Principles of State
rights envisaged by the Indian of status and of opportunity. Policy are enshrined in Part IV of the
Constitution to the vulnerable Indian Constitution. Article 38 says
sections. There are economic The Indian Constitution has that the State shall strive to promote
outlined through the Fundamental the welfare of the people by securing
empowerment programmes
Rights and the Directive the State’s and protecting effectively as it may a
envisaged under the policies policies for Social Inclusion. Part III social order in which justice, social,
of Government implemented of the Indian Constitution provides economic and political shall inform
through the apex Finance and for 6 Fundamental Rights for Social all the institutions of the national life.
Development Corporations. The Inclusion. These include Right to Article 39 provides for the abolition of
Equality, Right to Freedom, Right child labour and for equal pay for equal
comprehensive implementation
against Exploitation, Right to Freedom work for both men and women. Article
of national policies will enable of Religion, Cultural and Educational 41 provides for Right to Work, to
India to greatly empower her Rights and Right to Constitutional education, to public assistance in case
vulnerable population Remedies. These Rights are also of unemployment, old age, sickness
available to persons with disabilities. and disablement and in other cases of
The author is an IAS officer of 1989 batch and at present, posted as Chairman, Board of Revenue for Rajasthan and Chairman, Rajasthan
Tax Board. He has served as Deputy Director (Administration), AIIMS New Delhi and Secretary, Family Welfare and Mission Director,
NRHM, Government of Rajasthan.

40 YOJANA May 2018


undeserved want. Article 42 provides
for just and humane conditions of
work and for maternity relief. The
11th Schedule to Article 243 G says that
Social Welfare including the welfare of
the handicapped and mentally retarded,
and the 12th Schedule to Article 243 W
says that safeguarding the Interests of
Weaker Sections of Society including
the handicapped and the mentally
retarded.
Governance Structures
The Government of India’s
Social Inclusion programmemes
is implemented by the Ministries provides hostel facilities for Scheduled of Persons with Disabilities deals
of Social Justice & Empowerment, Caste boys and girls in middle schools, with the legislation governing
Tribal Affairs, Women and Child higher secondary schools, colleges different aspects of disability and
Development and Minority Affairs. and universities. For post-graduate SC welfare and empowerment of persons
students, the Government is providing with disabilities. These are the
Ministry of Social Justice and fellowships for M.Phil and PhD Rehabilitation Council of India Act
Empowerment 1992, The Persons with Disabilities
programmes through the University
The Ministry of Social Justice Grants Commission. The Central (Equal Opportunities, Protection of
and Empowerment implement 42 Government is also implementing Rights and Full Participation) Act 1955
schemes for the welfare of Scheduled National Overseas Scholarship and the National Trust for the Welfare
Castes. The Ministry seeks educational programme for SC students for Masters of Persons with Autism, Cerebral
empowerment, economic empowerment and PhD programmes in specified Palsy, Mental Retardation and Multiple
and social empowerment under its fields of study. Disabilities Act 1999.
various schemes. The Ministry is the
custodian of 2 Acts, specifically aimed The economic empowerment of There are 3 Statutory bodies under the
at curbing (i) untouchability and (ii) Scheduled Castes is through the special Department. The Rehabilitation Council
atrocities against Scheduled Castes central assistance to the scheduled of India is responsible for regulating
and Scheduled Tribes. These are the castes sub-plan (SCSP). Assistance is training policies and programmes for
Protection of Civil Rights Act 1955 and provided by the State Scheduled Caste various categories of professionals in
the Scheduled Castes and Scheduled Development Corporations, which the area of rehabilitation and special
Tribes (Prevention of Atrocities) Act implement economic development education. The Chief Commissioner
1989. The National Commission for schemes with the equity transferred for Persons with Disabilities is the
Scheduled Castes was set up under by the central government. The statutory functionary under the Act
Article 383 of the Constitution in State Scheduled Caste Development of 1955 to coordinate work of State
1990, to investigate and monitor all Corporations provide credit and Commissioners for persons with
matters relating to the safeguards inputs by way of margin money loans disabilities. The National Trust is a
provided for Scheduled Castes under and subsidy. India established the statutory body, which enables and
the Constitution and all Laws in force National Scheduled Castes Finance and empowers persons with disabilities to
and to inquire into specific complaints Development Corporation to provide live independently as fully as possible
with respect to deprivation of rights and concessional loans to Scheduled Castes and to extend support to registered
safeguards of the Scheduled Castes. families and skill cum entrepreneurial organizations providing need-based
training to the youth of the target services. India has set up 6 National
The educational empowerment of Institutes / Apex Level Institutes to deal
group living below double the poverty
scheduled castes is through Post Matric with the multi-dimensional problem of
Scholarships for Scheduled Caste line. The National Safai Karmacharis
Finance and Development Corporation disabled population in each major area
Students that provide for financial of disability. The National Handicapped
assistance to scheduled caste students has been established for economic
empowerment of scavengers and Finance and Development Corporation
studying at post-matriculation and is the apex level financial institution for
post-secondary stage to enable them to manual scavengers.
extending credit facilities to persons
complete their education. The financial Department for Empowerment with disabilities for their economic
assistance includes maintenance of Persons with Disabilities development.
allowance, fee reimbursement, book- (Divyangjan)
bank facility and other allowances. The The Accessible India campaign
Babu Jagjivan Ram Chhatrawas Yojana The Department for Empowerment is a nationwide flagship campaign to

YOJANA May 2018 41


Government in developing policies for
older persons.
Ministry of Women and Child
Development
The Ministry of Women and Child
Development was established in 2006
with the responsibility to advance
the rights and concerns of women
and children and to promote their
survival, protection, development
and participation in a holistic manner.
It was also expected to bring about
inter-ministerial and inter-state
convergence with regard to women
and child programmes. The National
Policy for Empowerment of Women
ensure a barrier-free and conducive financial assistance to empower tribals lays down detailed prescriptions to
environment for Divyangjans all over for undertaking self-employment address discrimination against women,
the country, launched by the Prime ventures. The National Commission strengthen existing institutions,
Minister on December 31, 2015, for for Scheduled Tribes was established provide better access to health care,
creating universal accessibility for under Article 338 A of the Constitution equal opportunities for women’s
persons with Disabilities. as an independent body to safeguard participation in decision making and
the rights of tribals. mainstreaming gender concerns in
Ministry of Tribal Affairs
National Policy for Older Persons developmental processes. The policies
The Ministry of Tribal Affairs and programmes of government have
was established with the objective India’s National Policy for Older been formulated on the lines of the
of providing a  focused approach Persons seeks to encourage individuals broader vision laid down by the
to the integrated socio-economic to make provisions for their own as well National Policy for Empowerment of
development of the Scheduled Tribes, as their spouse’s old age; to encourage Women.
in a coordinated and planned manner. families to take care of their older family
The scheduled areas are notified under members and to promote research and The Ministry of Women and Child
Article 244 (1) of the Constitution. training facilities to train geriatric Development is the custodian of
Article 244 (2) relates to those areas caregivers and organizers of services several Acts relating to women and
in the States of Assam, Meghalaya, for the elderly. The Government has children. Prominent among these
Tripura and Mizoram which are constituted the National Council for is the Dowry Prohibition Act, the
declared Tribal Areas and provides for Older Persons to advise and aid the Prohibition of Child Marriage Act,
District Councils/ Regional Councils
for such areas. 
The Ministry administers grants
to states comprising of special central
assistance to tribal sub-plan schemes,
grants under Article 275 (1) of the
Constitution of India, grants for the
Eklavya Model Residential Schools;
education grants for vocational training
centers in tribal areas, establishment
of ashram schools in Tribal Sub-Plan
areas, and livelihood support grants for
minimum support price for minor forest
produce. The Ministry also provides
equity support to the Tribal Cooperative
and Marketing Federation of India
and the State-Tribal Cooperative
and Marketing Federations. The
National Scheduled Tribes Finance and
Development Corporation provides

42 YOJANA May 2018


the Sexual Harassment of Women at women and child development. The no question of discrimination based on
Workplace (Prevention, Prohibition umbrella ICDS comprises of 6 sub- gender and stressed the importance of
and Redressal) Act, and the Juvenile components namely the Anganwadi girls getting access to quality education
Justice (Care & Protection of Children) services scheme, the Pradhan Mantri just like boys. Emphasizing that a
Amendment Act 2011. Matru Vandana Yojana, the National daughter is not a burden, the Prime
Creche Scheme, the Poshan Abhiyan, Minister said that girls are bringing
The National Commission of
the Scheme for Adolescent Girls and pride and glory to the Nation excelling
Women and the National Commission
for Protection of Child Rights have
Child Protection Scheme. The ICDS is in several fields.
aimed at improving the nutritional and
been established under the aegis Conclusion
child health status of children below
of Ministry of Women and Child
the age of six years and pregnant and
Development to safeguard the rights I n d i a ’s S o c i a l I n c l u s i o n
of women and protect children’s rights lactating mothers as also to reduce the
programmes are comprehensive and
respectively. The National Commission mortality, morbidity and malnutrition.
their implementation supervised by
on Women took up the “Violence Free The Beti Bachao Beti Padhao scheme
a number of independent Ministries
Home – A Women’s Right” campaign is to celebrate the girl child and enable
with adequate resource allocations. Not
for awareness generation in Delhi. her education. The main objectives
only have statutory legal provisions
The Protection of Children from of the scheme are to prevent gender-
been enacted, autonomous National
Sexual Offences Act 2012 came into based sex-selective elimination, to
Commissions have been established
force on 14th  November 2012, as a ensure survival and protection of the
to protect the rights envisaged by the
comprehensive piece of legislation that girl child and to ensure education and
Indian Constitution to the vulnerable
provides protection to all children under participation of the girl child. The
sections. There are economic
the age of 18 years from offences of scheme seeks to improve sex ratio at
empowerment programmes envisaged
sexual assault and sexual harassment. birth in selected gender critical districts
under the policies of Government
by 2 points a year.
Amongst the flagship schemes implemented through the apex Finance
implemented by the Ministry of On International Women’s Day and Development Corporations. The
Women and Child Development dated March 8, 2018, the Prime Minister comprehensive implementation of
are the Umbrella ICDS, Women launched the National Nutrition Mission National Policies will enable India
Empowerment Schemes like Beti and pan India expansion of Beti Bachao to greatly empower her vulnerable
Bachao Beti Padhao and a series of Beti Padhao at Jhunjhunu in Rajasthan. population.  q
grant in aid schemes in the field of The Prime Minister said that there was (E-mail: vsrinivas@nic.in)

The mantra of 3R – Reduce, Reuse and Recycle -


Is at the heart of any vision towards the sustainable development of mankind
The Eighth Regional 3R Forum in Asia and the Pacific was held at Indore in April 2018 with an overall theme of
“Achieving Clean Water, Clean Land and Clean Air through 3R and Resource Efficiency – A 21st Century Vision for
Asia-Pacific Communities”.
In a message to the participants of the 'Eighth Regional 3R Forum in Asia and the Pacific', the Prime Minister said, “The
mantra of 3R – Reduce, Reuse and Recycle- is at the heart of any vision towards the sustainable development of mankind. All
stakeholders –producers, consumers and the State alike must adhere to this golden principle which can contribute significantly in
solving the twin challenges of waste management as well as the sustainable development”.
3R FORUM : Aims and Objectives
The Forum aims to address how 3R and resource efficiency measures can provide complementary benefits in making
cities and countries clean, smart, liveable and resilient. The Forum also aims to generate policy-level, institutional level and
technological insights towards effective implementation of 3R and resource efficiency to foster circular economic development,
sustainable change in current use of natural resources and ultimately achieve a zero waste society.
In addition, the Forum seeks to engage the public and private sector to explore various partnership opportunities in
areas of 3R and waste management for moving towards a zero waste society. The Forum further provides an opportunity
to establish insightful linkages between the principles of 3R and resource efficiency and the objectives of Swachh Bharat
Mission (Clean India Mission). Through this Forum, India aims to strengthen this focus through its ‘Mission Zero Waste’ approach
thereby encouraging cities, industries and other diverse stakeholders to see look at waste as a resource.
The Eighth Regional 3R Forum in Asia and the Pacific is hosted by the Ministry of Housing and Urban Affairs, Government
of India, and co-organized by the Ministry of the Environment, Government of Japan, and the United Nations Centre for
Regional Development of the Division for Sustainable Development /United Nations Department of Economic and Social Affairs.
The Indore Municipal Corporation, Government of Madhya Pradesh, and Confederation of Indian Industry (CII) have been
designated as the City Partner, Organizing State Partner and Industry Partner respectively.

YOJANA May 2018 43


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44 YOJANA May 2018


SWASTHA BHARAT- SAMRUDDH BHARAT
INNOVATIVE STRATEGIES

Expanding Universal Health Coverage

Manisha Verma

he past four years have Council Act, 1956 for a uniform

T seen immense strides in


the health scenario of
the country.  Be it policy
changes, new programs or
entrance examination for admission
to all medical seats in the country. For
the first time under National Eligibility
cum Entrance Test (NEET), there is a
schemes, be it a financial push or global uniform entrance examination across
goals, considerable achievements in the country including private colleges
each facet of healthcare have been and deemed universities. Also, annual
made. The Government is committed sanctioned intake capacity has been
to the holistic development and thus increased from 3 per cent to 5 per cent
health has been a focus area under its for persons with benchmark disabilities
There has been a ‘Sabka Saath, Sabka Vikas’ mandate. in accordance with the provisions of
sharpened focus The mandate of Ministry of Health the Rights of Persons with Disabilities
and Family Welfare (MoHFW) is to Act, 2016, based on the merit list of
towards providing ensure that the health services reach National Eligibility-Cum-Entrance Test
the most vulnerable and the unserved for admission to Medical Courses.
affordable, accessible populations. To fulfil this, the Ministry
quality healthcare has taken up initiatives to ensure and Another landmark initiative to
expand Universal Health Coverage expand the universal health coverage
through various (UHC). across the country is- Ayushman
Bharat. With its two components viz.
strategic interventions. On the policy front, one of Comprehensive Primary Health Care
These have covered a the significant steps has been the (CPHC) through 1.5 lakh Health and
announcement of the National Health Wellness Centres (HWCs) and the
whole gamut of health Policy 2017, after a gap of 15 years, National Health Protection Mission
services, manpower to address the current and emerging (NHPM), it is a huge step towards
challenges necessitated by the changing UHC. The Prime Minister launched
strengthening socio-economic and epidemiological the HWCs at Jangla, district Bijapur
initiatives and steps landscapes of the country. While (Chhattisgarh) on April 14, 2018
the Policy touched all components embarking India on its journey towards
to meet infrastructure of healthcare in the country, it has UHC. The NHPM is poised to be the
demands.  The efforts brought focus to preventive and largest public funded health insurance
promotive health, primary health care scheme in the world. It will cater to
are in the direction and ensuring access, affordability and the unmet needs of the population
of achieving Swastha quality of health services. The other which remained hidden due to lack
policy initiatives have been the Mental of financial resources. It aims to
Bharat, Samruddh Healthcare Act, 2017, HIV and AIDS protect the poorest from catastrophic
Bharat (Prevention and Control) Act- 2017 healthcare spending. Health insurance
and amendment of the Indian Medical cover of Rs. 5,00,000/- per family/

The author is Director, Media and Communication, Ministry of Health and Family Welfare, Government of India.

YOJANA May 2018 45


per year will be provided to  50 key processes
crore people (from about 10 crore related to the
families). This shall benefit nearly 40 labour rooms
per cent of the population, covering and maternity
almost all secondary and many tertiary operation
hospitalizations. theatres.
The Health Ministry has been To e n s u r e
persistently working on ensuring a c c e s s i b i l i t y,
accessibility, affordability and under NHM,
quality of health services with there are at
special focus on reducing the Out Of present 1416
Pocket Expenditures (OOPE) of the Mobile Medical
beneficiary. Under the flagship program units (MMUs) mode scheme, 2.55 crore children
National Health Mission (NHM), free and 24276 ambulances (104/108) have been vaccinated and 66.57 lakh
essential drugs and diagnostics are operational across the country. In fully immunized along with 68.78 lakh
provided at all public facilities across order to strengthen the infrastructure pregnant females being immunized.
29 States/UTs through the Free Drugs of the public health systems, 7990 The first two phases of MI alone have
and Diagnostics program. Another constructions and 9615 renovations led to an increase of 6.7per cent in
innovative initiative is the Affordable have been completed, 73879 ASHAs full immunization coverage in one
Medicines and Reliable Implants For selected across the country and year as compared to the 1per cent
Treatment (AMRIT). Through 124 provided 76283 health kits and 8149 annual increase in the past. Not only
AMRIT Pharmacies spreads across AYUSH doctors have been engaged.  this, the target to achieve 90 per cent
22 States, more than 5200 drugs
A singular and landmark full immunization has been advanced
(including cardiovascular, cancer,
diabetes, stents, etc), implants, surgical achievement has been-India was by the  Prime Minister in December
disposables and other consumables are validated for Maternal and Neonatal 2019. To achieve this, the Intensified
sold at a significant discount of up to 50 Tetanus Elimination (MNTE) in April Mission Indra dhanush was launched
per cent on market rates. Drugs having 2015, much ahead of the global target by Prime Minister on October 8, 2017
MRP Value of Rs. 566.34 Crores have date of December 2015.  What is at Vadnagar, Gujarat to be carried out
been dispensed at Rs. 254.36 Crores, perhaps noteworthy is that India’s in 121 districts, 17 urban areas and
resulting in saving of Rs. 311.99 Crores Under-five Mortality Rate and Maternal 52 districts of NE states (total 190
to the patients. The Pradhan Mantri Mortality Ratio declined at a higher districts/urban areas across 24 states).
National Dialysis Program (PM-NDP) pace than the global average. The
Not just immunization, MoHFW
has served 2,37,139 patients, conducted percentage annual compound rate
implements several programs to cater
22,84,353 free dialysis session through of decline in IMR during the period
to each life stage of a child i.e. ante-
the 497 dialysis operational units/ of the National Health Mission also
natal to adolescent and thereunto
centres and 3330 total operational accelerated from 2.1 per cent to 4.5 per
family planning and pregnancy. The
dialysis machines under it. cent. The Total Fertility Rate (TFR) of
MAA-Mother’s Absolute Affection has
the country has declined from 3.8 in
Also, as part of its maternal health enhanced the focus on breastfeeding.
1990 to 2.9 in 2005 to 2.3 in the year
programs, 388.65 lakhs mothers have Through Intensified Diarrhoea Control
2013 and 24 States/UTs have already
been benefitted under the Janani Sishu achieved replacement level of less
Fortnight (IDCF) to combat mortality
Yojana (JSY) with an expenditure of in children due to childhood diarrhoea,
than 2.1.
Rs. 6485.17 crore. This has brought the more than 22.3 crore under-5 children
institutional delivery in the country to A significant accomplishment were reached since 2014.More than
78.9 per cent (NFHS-4, 2015-16) from has been an expansion of the world’s 97 Crore doses of Albendazole have
47 per cent (DLHS-3, 2007-08). The biggest public health intervention i.e. been administered to children in the
new program Pradhan Mantri Surakshit Universal Immunization Program 1-19 year group, since 2014 as part
Matritva Abhiyan has helped identify (UIP), by launching five new vaccines of the National Deworming Day
more than 6 lakh high-risk pregnancies (Measles-Rubella, Pneumococcal, (NDD) to combat Soil-Transmitted
through more than 1.16 crore antenatal Rotavirus, Inactivated Polio and Helminth (STH) infections. Also, 1150
check-ups. Another new initiative has Japanese Encephalitis), bringing total Nutritional Rehabilitation Centres
been LaQshya – ‘Labour room Quality to 12 vaccines. Mission Indra dhanush (NRCs) have been established for
improvement Initiative’ launched on (MI) was an important component of the management of severe acute
December 11, 2017. It is a focused UIP and has completed its 4 phases malnutrition in under-5 children all
and targeted approach to strengthen in 528 districts. Under this Mission across the country. The Rashtriya Bal

46 YOJANA May 2018


Swasthya Karyakram (RBSK) entails services. Since July
provision for child health screening 2014, 1675 hospital beds
and early intervention services through have been added in the
early detection and management of six functional AIIMS
4 Ds i.e. Defects at birth, Diseases, (including 850 beds
Deficiencies, Development delays and added in the last one
free management of 30 identified health year) and 2 new AIIMS
conditions including surgery at tertiary announced for Jharkhand
health facilities. Until September and Gujarat in 2017-18.
2017, a total of 1.55 Crore children Basket of services in
have received treatment under the six AIIMS have been
programme. With a high focus on the expanded and presently,
adolescent health, the Rashtriya Kishor on an average, about
Swasthya Karyakram (RKSK) was 1663 major surgeries are
rolled out. It covers all patients with
launched. Under this, 7516 Adolescent getting performed every month. Also,
Anti Retro Viral (ARV) irrespective
Friendly Health Clinics (AFHCs) have construction of Super Specialty Block
of CD count or clinical stage. This has
been established across the States to in four GMCs completed, adding up to
902 hospital beds, six Super Specialty brought more than 1 lakh additional
provide Adolescent Friendly Health HIV infected people under the ambit
Services. Approximately, 60 lakh Departments and three Trauma Centres
and Cabinet approval obtained for 13 of ARV treatment. This also means that
adolescents receive counselling and more than 11.75 lakh people infected
clinical services at these clinics in a more GMC up-gradation projects.
In the sphere of medical education, with HIV are on ARV treatment; 54per
year. cent higher than the March’14.
total 92 Medical College (46 Govt.
The Ministry has accorded and 46 Pvt.) have been set up in the The NHP 2017 clearly states
priority to population stabilisation. last four years. This has resulted in an
tapping of IT for healthcare, and
Mission Parivar Vikas programme increase of 15354 MBBS seats (6519
MoHFW has several IT initiatives
was launched in 2016 for increasing in Government Colleges and 8835
including development of “inter-
access to contraceptives and family in Private Colleges) and total 12646
PG Seats (Broad and Super Specialty operable Electronic Health Records
planning services in 146 high fertility
Course) in last four years. (EHR) system, telemedicine services,
districts with key initiatives. Under
public health IT solutions (Mother
this, new contraceptives are made
The Prime Minister has announced and Child Tracking System (MCTS)
available till the Sub-Centre Level.
the achievement of a TB Free India by / Reproductive Child Health (RCH)
As part of NayiPehel, family planning
2025. In order to make this a reality, as application, Kilkari App, Mobile
kit is provided by the ASHAs to the
part of Revised National Tuberculosis Academy, ANM on Line (ANMOL),
newlyweds. Saas Bahu Sammelan Control Program (RNTCP), treatment
are held to encourage young married Drugs and Vaccines Distribution
for drug-sensitive TB is provided Management System (DVDMS)
women and their mothers-in-law to through a network of more than 400,000
freely discuss matters related to family (‘e-Aushadhi’), TB Patient Monitoring
DOT Centres, diagnosis of drug- System “Nikshay”, SUGAM by Central
planning and reproductive health. resistant TB drug susceptibility testing
Beyond this program, three new Drugs Standards Control Organisation
at 74 culture and drug susceptibility (CDSCO)  and eRaktKosh etc.) and
contraceptives are added to the basket testing (C-DST) laboratories. Also,
of family planning choices: injectable web portals and mobile applications
the steps include quality diagnosis (National Health Portal (NHP),
C o n t r a c e p t i v e M PA ( M e d r o x y through more than 14000 designated
Progesterone Acetate) under Antara PMSMA Portal, MeraAspataal (My
microscopy centres and house to
Programme, Centch roman (Chhaya) Hospital), mDiabetes Program, India
house screening of TB symptoms
and Progesterone Only Pills and Fights Dengue App etc.)
covering 5.5 crore population under
injectable and Centchroman rolled out Active Case Finding. Acknowledging There has been a sharpened
across the country. that nutrition plays a very crucial role focus towards providing affordable,
in the treatment of TB patients, the accessible quality healthcare through
To strengthen and augment the
Government has approved Rs. 500 various strategic interventions. These
medial infrastructure in the country,
per month for nutritional support to have covered a whole gamut of health
under Pradhan Mantri Swasthya
all TB patients for the duration of TB services, manpower strengthening
SurakshaYojana (PMSSY), new AIIMS
treatment through DBT (as announced initiatives and steps to meet
have been announced and medical
in Union Budget 2018-19).
colleges set up in various districts. The infrastructure demands.  The efforts are
program aims at correcting regional As a visionary step, under the in the direction of achieving Swastha
imbalances in the availability of National AIDS Control Program Bharat, Samruddh Bharat.  q
affordable/reliable tertiary healthcare (NACP), Test and Treat’ Policy has been (E-mail: pibhealth@gmail.com)

YOJANA May 2018 47


/8.0$$1,$6
352*5$06)25&6(
21/,1(2))/,1(

YE-819/2018

48 YOJANA May 2018


do you know?
THE PARTNERSHIP
FOR MATERNAL, NEWBORN AND CHILD HEALTH

T he Partnership for Maternal, Newborn and Child Health (PMNCH) is an alliance of more than
1000  organisations  present in 77 countries.   This multi-constituency partnership is hosted by the  World
Health Organization  and headquartered at Geneva, Switzerland. The Partnership provides a platform for organisations to
align objectives, strategies and resources and agree on interventions to improve maternal, newborn, child and adolescent
health.
PMNCH works with its members in the Reproductive, Maternal, Newborn and Child Health (RMNCH) communities
across the 10 constituencies. These  constituencies are–1. Partner countries;   2. Donors and foundations;   3.
Intergovernmental Organisations; 4. Non-Governmental Organisations; 5. Academic, research and training
institutions;  6. Adolescents and youth;  7. Healthcare professional associations;  8. Private sector partners,  9. UN
agencies and  10. Global financing mechanisms.
The Partnership was formed in September 2005, bringing together 80 members from three organizations, which
included the Partnership for Safe Motherhood and Newborn Health, the Healthy Newborn Partnership and the Child
Survival Partnership, with the mandate to strengthen alignment and consensus building to support the achievement
of the Millennium Development Goals (MDGs), especially MDGs 4 and 5, calling for the reduction of under-five
child mortality and maternal mortality. The Partnership focused particularly on the importance of delivering the full
continuum of care spanning sexual and reproductive health needs and rights of women and adolescents, pregnancy
care, safe delivery, the first weeks of life and the early years of life.
Vision and Mission
A world in which every woman, child and adolescent in every
setting realize their rights to physical and mental health and
wellbeing, has social and economic opportunities and is able
to participate fully in shaping prosperous and sustainable
societies.
The Mission of the Partnership is to increase the engagement, alignment and accountability of partners, by creating
a multi-stakeholder platform that will support the successful implementation of the Global Strategy for Women’s,
Children’s and Adolescents’ Health, enabling partners to achieve more together than any individual Partner could do
alone.
The Partnership has a vital mandate to engage, align and hold accountable multi-stakeholder action to improve the health
and well-being of women, newborns, children and adolescents, everywhere.  The Partnership concentrates on its core
strengths – alignment, analysis, advocacy and accountability. These 4 ‘A’s are to contribute to the Every Woman Every
Child Movement and provide support to all partners to work together to achieve the full range of targets for the Global
Strategy by 2030 with a priority focus on targets. These targets include -1. Reduce global maternal mortality to 70 or
fewer deaths per 100,000 live births [SDG3.1], 2. Reduce newborn mortality in every country to 12 or fewer deaths per
1,000 live births [SDG3.2]  3. Reduce under-five mortality in every country to 25 or fewer deaths per 1,000 live births
[SDG3.2] and 4. Achieve universal access to sexual and reproductive health and reproductive rights [SDG3.7/5.6]; 
5. Ensure at least 75 per cent of demand for family planning is satisfied with modern contraceptives.
The Partners’ Forum
The Partners’ Forum is the over-arching decision-making body of  PMNCH-‘The Partnership’ which is made up of all
constituencies and members and meets biennially during a global maternal, newborn and child health conference.
The Partners’ Forum has representatives from each constituency group to serve on the Board; It consolidates and
increases members’ commitment to the objectives of 'The Partnership' and maintains and reinforces high-level political
commitment. The forum enriches plans and activities through the active exchange of information and experience. It
also highlights any special opportunities and constraints that would warrant the attention of the Board. There have
been three Partners’ Forums to date: 2008 in Tanzania, 2010 in India and 2014 in South Africa.
At present, the Board is chaired by Mrs. Graça Machel. Her contributions to the Africa Progress Panel and the United
Nations Secretary-General’s Millennium Development Goals Advocacy Group have been widely appreciated. The Board
is co-chaired by Shri  CK Mishra, Government of India and Dr. Flavia Bustreo, the World Health Organisation.
Contd. on next page...

YOJANA May 2018 49


Contd. from previous page...

Recent activities
The 138th Inter-Parliamentary Union (IPU) Assembly was held from March 25 -28, 2018 in Geneva, Switzerland.
PMNCH, in collaboration with IPU and the World Health Organisation (WHO), organized the session ‘Ensuring
accountability and oversight for adolescent health’.
A Delegation of ‘The Partnership for Maternal, Newborn and Child Health (PMNCH)’ including Shri J. P. Nadda,
Union Minister of Health and Family Welfare and Dr. Michelle Bachelet, former President of Chile and incoming
Board Chair of PMNCH called on the Prime Minister Shri Narendra Modi in New Delhi on April 11, 2018. The Prime
Minister graciously agreed to be Patron of the PMNCH Forum and accepted the Logo of the forum.
The upcoming Partners Forum 2018 will be hosted at New Delhi during the December 12-13, 2018. As a key event
in the global development calendar, the Partners’ Forum will enhance momentum for the country implementation of
the Every Woman Every Child Global Strategy for Women’s, Children’s and Adolescents’ Health (2016-2030), and
the 2030 Sustainable Development Goals more broadly. Capping an important year for progress in 2018, the Partners’
Forum will consolidate multi-stakeholder support for shared financing goals for women, children and adolescents,
amplifying the replenishment call of the Global Financing Facility (GFF). The Partners Forum will also act upon the
newly published recommendations of the 2017 Independent Accountability Panel (IAP) report, offering an inclusive
platform for the joint review of progress made under the 2020 EWEC Partners’ Framework.

BENEFICIARIES OF PRADHAN MANTRI MATRU VANDANA YOJANA (PMMVY) 


CROSSES 22 LAKHS

T he Ministry of Women and Child Development has made total payment of


Rs. 271.66 crores to beneficiaries under Pradhan Mantri Matru Vandana Yojana
(PMMVY). The payment has been made to 11,47,386 beneficiaries across the
country. The Ministry is constantly monitoring the implementation of the scheme
and taking steps so that the benefits of the scheme can be availed by maximum
number of people.
Number of beneficiaries enrolled under Pradhan Mantri Matru Vandana Yojana
(PMMVY) has increased to 22,04,182. So far, Rs. 2048.59 Crores to all 36 States/
UTs have been sanctioned under PMMVY out of which Rs. 2048.40 Crores have
been released.
The Government of India has approved Pan-India implementation of PMMVY in all districts of the country from
January 1, 2017 under which the eligible beneficiaries get Rs. 5,000/- under PMMVY and the remaining cash incentive
as per approved norms towards Maternity Benefit under Janani Suraksha Yojana (JSY) after institutional delivery so
that on an average, a woman gets Rs. 6000/-.
The Scheme Implementation Guidelines, the software for roll out of the Scheme i.e. Pradhan Mantri Matru Vandana
Yojana - Common Application Software (PMMVY- CAS) and its User Manual were launched on 01.09.2017 by the
Hon’ble Minister of Women & Child Development, Smt Maneka Sanjay Gandhi. PMMVY is being implemented in
collaboration with State Governments.
The maternity benefits under Pradhan Mantri Matru Vandana Yojana (PMMVY) are available to all Pregnant Women and
Lactating Mothers (PW&LM) except those in regular employment with the Central Government or State Government
or Public Sector Undertaking or those who are in receipt of similar benefits under any law for the time being in force,
for first living child of the family as normally, the first pregnancy of a woman exposes her to new kind of challenges
and stress factors. The objectives of the scheme are: (i) providing partial compensation for the wage loss in terms of
cash incentives so that the woman can take adequate rest before and after delivery of the first living child; and (ii) the
cash incentives provided would lead to improved health seeking behaviour amongst the Pregnant Women and Lactating
Mothers.

Yojana
India on the move
Forthcoming Issue

50 YOJANA May 2018


YE-830/2018

YOJANA May 2018 51


Health Metrics
last mile access

Decentralised Approach to Tackling Nutrition

Avani Kapur

here should the is today’s child or foetus and events

W government invest if it
wants to maximise India’s
long-run economic
growth, given fiscal
and capacity constraints? This was
occurring while the child is in the
womb or at a very young age can cause
irreparable damage which lasts into
adulthood. Possibly, the most striking
visual representation of the impact that
the question posed in the 2015-16 poor nutrition can have on deprivation
Economic Survey. The short answer – in the brain can be found in the latest
“the highest economic returns to public World Development Report. Focussed
investment in human capital in India on the global learning crisis, the
lie in maternal and early-life health report shows significant differences
On September 20, 2017, and nutrition interventions”(Ministry in the  magnetic resonance imaging
the  Government of India of Finance, 2016). (MRI) scan of the brain of two infants
committed to investing aged 2-3-month olds – one who stunted
It is a well-recognised fact that
Rs. 12,000 crores over the globally, nutrition-related factors
while another that wasn’t.
next 3 years for improving contribute to about 45 percent of Then there is also the pure
maternal and child health child deaths under age 5. India is no economics of nutrition. On the one
exception-   33  per  cent   of the total hand, several billion dollars are lost
and increasing the cost disease burden was caused by maternal, annually in terms of lost gross domestic
norms of the Supplementary neonatal and nutritional diseases. product (GDP) due to malnutrition.
Nutrition Programme. (Institute for Health Metrics and These losses include both direct
This was accompanied by Evaluation, Public Health Foundation losses in physical productivity due
of India,  and   Indian Council for to mortality but also indirect losses
the launch last month of from poor cognitive skills, loss of
Medical Research, 2017)
National Nutrition Mission schooling or due to increased health
(NNM) with a three-year However, increasingly a large body care costs. Concurrently, the returns
of evidence from epidemiology and
budget of Rs. 9046.17 crore economics has shown that that mortality
on investments preventing malnutrition
are extremely high. The 2016 Global
commencing from 2017-18 aside, poor nutrition in the first 1000 Nutrition Report estimated that for
with a vow to make India free days – from a woman’s pregnancy to every one dollar invested in nutrition
from malnutrition by making the child’s second birthday - can lead could yield a return of 16 dollars. 
to stunted growth, impaired cognitive
Poshan Abhiyan the next ability, poor performance in schools
(International Food Policy Research
“Jan Andolan” and a negative impact on the country’s
Institute, 2016)
workforce development.  (World Tackling malnutrition, however, is
Bank, 2018).  Tomorrow’s  workforce no easy task. Nutritional interventions
The author is a Fellow at the Centre for Policy Research (CPR) and Director of the Accountability Initiative (AI). The focus of
her work has been in building evidence for policy advocacy to strengthen transparency and accountability in public financial
management for service delivery. As part of her work, she is leading research studies on health, sanitation, nutrition and education
financing.

52 YOJANA May 2018


for children in isolation can have
only a modest impact. Instead,
what is required is a holistic and
comprehensive plan – with multiple
interventions ranging from increased
access to health services right from
adolescent stages, improved diet and
supplements such as fortification,
counselling and improved sanitation.
Moreover, given the different forms
of malnutrition, the timing and type of
nutritional interventions can also make
a significant difference. While wasting
or low weight for height is usually
the symptom of acute undernutrition
due to insufficient food intake or
diseases such as diarrhoea; Stunting
or low height for age refers to chronic of March 2015, 15 per cent of total comprehensive approach is specified,
malnutrition which occurs over time ICDS beneficiaries were malnourished. institutional structures such as the
(generally occur before age two) and This increased to 22 per cent as National Council on India’s Nutritional
its effects are largely irreversible. of March 2016 and 25 per cent as Challenges and Executive Committees
of September 2017.(Accountability have been set up; nutrition specific and
Till date, India has seen mixed
Initiative, 2018) sensitive schemes have been mapped
results in past approaches to tackling
and access to sanitation facilities has
malnutrition. Despite over 4 decades While these numbers are worrying, simultaneously improved.
of the Integrated Child Development over the last year, momentum around
Services (ICDS) scheme and a host of nutrition has been steadily building. The NNM has set itself a steep
other programmes tackling nutrition, Union and State governments along with target of reducing stunting by 2 per
between 2005-2015, as per the third other stakeholders have acknowledged cent, anaemia by 3 per cent and low
and fourth round of the National nutrition as a key component of birth weight by 2 per cent every
Family Health Survey (NFHS), while development. On September 20, 2017, year. However, given the complexity
the percentage of children under 5 who the  Government of India committed to and diversity of the issue, a routine
were underweight decreased from 43 investing Rs. 12,000 crores over the centralised, target driven approach
per cent to 36 per cent, the percentage next 3 years for improving maternal towards implementing the programme
of children who were wasted, increased and child health and increasing the cost may not work. Instead, for the mission
by 1 percentage point, while those that to succeed, a decentralised approach
norms of the Supplementary Nutrition
were severely wasted increased by 2 with a focus on the first principles –
Programme (Press Information Bureau,
percentage points. These findings are 2017). This was accompanied by the
namely the 3 Fs – funds, functions and
consistent with the official reported launch last month of National Nutrition
functionaries will be critical.
number of ICDS beneficiaries. As Mission (NNM) with a three-year Flexible Financing
budget of Rs. 9046.17
crore commencing The first step in ensuring the
from 2017-18 with success of the programme is to get
a vow to make India the financing right. Not only are costs
free from malnutrition of delivering nutrition interventions
by making Poshan different across states and districts,
Abhiyan the next but analysis undertaken of the NFHS
“Jan Andolan”. (Press at both the state and district level, as
Information Bureau, well as the previous Rapid Survey of
2018) Children (RSOC), have highlighted
significant inter-state and intra-state
On paper and variation on achievement in nutritional
policy – the recent outcomes. (Chakrabarti, Kapur, Vaid,
interventions on and  Menon, 2017; NITI Aayog, n.d.).
nutrition have all For instance, while less than 17 per
the right ingredients. cent of children under 5 are stunted
Funds have been set in Kerala, the proportion is over 40
aside, the need for a per cent in Uttar Pradesh and Madhya

YOJANA May 2018 53


Pradesh.  Similarly, while districts in mentioned, there is no real point in critically the ability to create a holistic
Bihar and Jharkhand have the highest spending resources on skill development plan focussed right from adolescent
prevalence of wasting; districts in if our children do not have the cognitive care to maternal and child health care.
Uttar Pradesh and Madhya Pradesh ability or productivity developed in the In order to strengthen coordination
topped the list in terms of high levels early years. across Ministries and have clear lines of
of stunting. (NITI Aayog, n.d.) accountability, roles and responsibilities
We have detailed district-level and accountabilities of each member
Centrally Sponsored Schemes information on different aspects of within the bureaucracy will need to
(CSSs) are designed and funded malnutrition from NFHS-4. The NITI be clearly defined and articulated.
primarily by the Union Government Aayog has also put up disaggregated Essential thus to the success of India’s
whilst states and local governments are data on the current status of nutrition, nutrition strategy will be clearly
responsible for the implementation and available for public view. (NITI Aayog, defined institutional arrangements not
execution of the scheme. Despite an n.d.) just at the National level and state level
endeavour to ensure flexibility in design (as already envisaged in the nutrition
Moreover, through the
through decentralised planning, most missions) but also in the districts that
implementation of a common platform
often uniform fixed norms mean that allow multiple levels of jurisdiction
for real-time monitoring at the last mile
states and local level functionaries have to work together. This further needs a
will further enable the ability to use the
limited flexibility in implementation. clear and detailed articulation of roles
data to make local decisions. Thus, if
Added to this is the common problem and responsibilities across different
for instance a state or a district or even
of inadequate fund flows to the last layers of government and efforts to
a panchayat wants to tackle nutrition by
mile. For proper implementation of enhance capacity.
focusing on ending open defecation, it
schemes smooth flow of funds needs
should have the flexibility to determine
to be ensured. Focus on the Functionaries
its own roadmap.
The government has already Finally, lower and mid-level
announced incentivising states through Clearly Defined Functions bureaucrats and front-line workers
finances by providing performance With funds in place, functions at the last mile are critical resources
incentives. Additionally, however, should follow. Despite attempts at in the implementation of government
it will be essential to also provide convergence in the past, evidence from schemes and can make or break
enhanced flexibility such that states the field suggests that the integrated the state’s ability to deliver on its
or even districts can choose from approach to nutrition services have promises. For nutrition, the Triple
a basket of interventions based on not been able to achieve desired results. A – AWWs, ASHAs and ANMs are
their current level of nutritional Each department usually implements the key implementers, responsible
development. This, in turn, may even programmes through a unique planning, for the delivery of essential services
require pooling resources across budgeting and management system that on the ground. Yet, for many years,
ministries or departments. Given the holds officers accountable upward the government have been grappling
multidimensionality of nutrition, it to the individual department.The with acute shortage of staff. In
would probably do more good if multi-dimensional nature of nutrition, such a scenario, the short-staffed
relevant ministries/departments could however, requires not just coordination delivery systems are only able to
set aside a proportion of their budgets amongst a host of ministries – water, focus on routine activities such as
to tackle nutrition. As previously sanitation, health, education, but most supplementary nutrition and staff

54 YOJANA May 2018


salaries and expenditure on, and implementation of,
softer items such as innovation, counselling and training,
etc. are neglected. While endeavour to equip AWWs
with smartphones and tablets will reduce administrative
costs and time in filling multiple registers is excellent,
technology can only do so much. Long-term, sustainable
efforts at behavioural change will require fixing these
capacity constraints urgently.
The recent policy and political push for nutrition have
already defined a number of these steps.  (NITI Aayog).
However, experience has shown us, implementation is
usually India’s Achilles heel. The journey ahead is long
and arduous but in order to address the multidimensionality
of malnutrition and the long-term effects it can have on
economic and cognitive development, multiple stakeholders
and local service delivery models will need to be tried in a
decentralised manner.
References
Accountability Initiative. (2016). PAISA: Social Sector
Spending in Chhattisgarh.  New Delhi: Centre for Policy
Research.
Accountability Initiative. (2018).  Budget Briefs,
Integrated Child Development Services 2018-19. New Delhi:
Centre for Policy Research.
Chakrabarti, S., Kapur, A., Vaid, A., & Menon, P.
(2017). Achieving the 2025 World Health Assembly Targets
for Nutrition in India: What Will It Cost?  New Delhi:
International Food Policy Research Institute.
Institute for Health Metrics and Evaluation, Public
Health Foundation of India, & Indian Council for Medical
Research. (2017). India: Health of the Nation’s States- The
India State-Level Disease Burden Initiative.  New Delhi:
ICMR; PHFI, and IHME.
International Food Policy Research Institute.
(2016).  Global Nutrition Report 2016: From Promise to
Impact: Ending Malnutrition by 2030. Washington, DC.
Ministry of Finance. (2016).  Economic Survey 2015-
16. Delhi: Government of India.
NITI Aayog. (n.d.).  Nourishing India: National
Nutritional Strategy. New Delhi: Government of India.
NITI Aayog. (n.d.). Nutrition Data of India’s States and
Districts. Retrieved from NITI Aayog:  http://niti.gov.in/
content/nutrition-charts#
Press Information Bureau. (2017, September 20). Cabinet
approves an increase of cost norms for Supplementary
Nutrition provided in Anganwadis and in the Scheme for
Adolescent Girls. Delhi.
Press Information Bureau. (2018,  March 08). PM
launches National Nutrition Mission, and pan India
expansion of BetiBachaoBetiPadhao, at Jhunjhunu in
YE-746/4/2017

Rajasthan. Delhi.
World Bank. (2018). World Development Report. World
Bank Group. q
(E-mail: akapur@accountabilityindia.org)

YOJANA May 2018 55


YE-802/2/2017

56 YOJANA May 2018


NORTH EAST DIARY
FIRST MEETING OF THE 'NITI FORUM FOR NORTH EAST'

he first meeting of the newly constituted ‘NITI


T Forum for North East’ was held in Agartala,
Tripura on April 10, 2018. The meeting was organized
by the NITI Aayog, Ministry of DoNER and the
North Eastern Council (NEC). On this occasion, Vice
Chairman of NITI Aayog Shri Rajiv Kumar said the
focus of development projects in the NER will be
based on the concept of “HIRA” (Highways, Inland
Waterways, Railways and Airways) as spelled out
by the Prime Minister. He said emphasis will also be
made on Education, Health and Skill Development
in the region. He further said that Horticulture, Tourism, Food Processing, use of Bamboo and Made in North-
East will be developed through five Mission Mode projects in a time-bound manner. The ‘NITI Forum for North
East’ was constituted in February 2018 with an aim to ensure sustainable economic growth of the North Eastern
Region (NER) of the country and periodically review the development status in NER.

BOOST FOR DEVELOPMENT PROJECTS IN NORTH-EAST

n March 28, 2018, the Union Cabinet approved the following schemes of Ministry of Development of North East
O Region (DoNER ) for continuation till March, 2020.
l Under the Schemes  of  NEC-Special   Development  Projects, with the  existing funding pattern (90:10 basis) for
ongoing projects and on 100 per cent Central funding for new projects;
l For other projects funded by NEC-both Revenue and Capital - as 100 per cent Central funding basis, to continue
with existing pattern;
l Extension   of   100 per cent centrally   funded   North   Eastern   Road   Sector Development Scheme
(NERSDS);
l Transfer to  NEC for implementation,  the  Non-Lapsable Central  Pool  of Resources (NLCPR-C);
l Proposal to ensure   optimization of resources through convergence of efforts of various Ministries/Departments.
The projects under the existing Schemes of NEC, NLCPR (Central) and NERSDS will accrue socio-economic benefits
to the people of North Eastern Region enhancing their capabilities and livelihood.
Presently, the major chunk of projects (599 projects out of 840) with 72.12 per cent approved cost (Rs.5375.12 crore
out of total Rs.7453.02 crore) and 66 per cent of pending liabilities (Rs 1518.64 crore out of Rs 2299.72 crore) for all
ongoing projects is funded through “the Schemes of NEC- Special Development Project”-wherein funds for the selected
projects are shared between Centre and State on 90:10 basis and the execution of work is done by the respective State
Governments. Apart from this, some funds are provided - both Revenue and Capital - as 100 per cent Central funding
basis, implemented through State and Central agencies. The Scheme of NEC - Special Development Project will be
changed to be a Central Sector Scheme with 100 per cent grant, instead of the earlier block grant on 90:10 basis. The
remaining component will continue to be funded on 100 per cent Central funding basis as at present.
Apart from the above, NEC is also implementing “North Eastern Road Sector Development Scheme - Programme
Component” for upgradation of the important and strategic inter-state roads. Transferred from DONER to NEC for
implementation, the scheme is 100 per cent Centrally funded. A sum of Rs. 1000 crore has been allocated under the
scheme.
Another Scheme namely “Non Lapsable Central Pool of Resources-Central [NLCPR (Central)]”, presently funded by
M/o DoNER, provides resources to the concerned line Ministries/their agencies for projects like Agartala-Akhaura Rail
Link, checking erosion in Majuli Island. This Scheme will also be transferred to NEC for implementation. Previously,
there was no fixed arrangement for distributing the funds into State or Central component.  Now, the total funds available
to NEC are proposed to be bifurcated in two components (State component - 60 per cent and Central component – 40
Contd. on next page...

YOJANA May 2018 57


Contd. from previous page...
per cent ).  The State component would be utilised for the projects in each State as per their share on normative allocation
basis.  For the Central component, the projects having regional character, requiring Inter-Ministerial intervention are to
be taken up. Priority sectors have been identified such as bamboo; piggery; regional tourism; higher education, tertiary
healthcare & special intervention in backward areas; livelihood project; Science and Technology Interventions in NER;
Survey & Investigation and NER Promotion.
  By the above, a clear apportionment or division of sectors is ensured between DoNER and NEC to avoid
duplication.
In order to give a boost to the Tourism in NE Region, amongst other things,  the outstanding liabilities in tourism
sector under Product Infrastructure Development for Destinations & Circuits (PIDDC) may also be addressed.
Further, a mechanism on the pattern of Standing Finance Committee  (SFC) with representatives from the concerned
line Ministries and from Ministry of DoNER would be constituted under the Chairmanship of Secretary, NEC for
approval of the projects costing between Rs. 5-15 crore. This is aimed at bringing synergy with programmes of other
Union Ministries and avoiding of duplication through process of SFC.

FUNDS ALLOCATION AND EXPENDITURE FOR NORTH EASTERN REGION

he Data regarding allocation of funds to Ministry of Development of North Eastern Region and expenditure
T incurred during the period 2014-2015 to 2017-2018 is given below:-
(Rs in crore)
  2014-2015 2015-2016 2016-2017 2017-2018
Budget Estimates 2332.78 2362.74 2430.01 2682.45
Revised Estimates 1825.45 2000.14 2524.42 2682.45
Actual Expenditure  1719.13 1986.79 2495.84 2568.17 (Provisional)

  Ministry of Development of North Eastern Region provides assistance for projects prioritized by State
Governments of North Eastern States for filling gaps in physical infrastructure. North Eastern Council provides funds
mostly to the State Governments for projects in sectors like agriculture, education, tourism, health, air connectivity,
power, water development, tourism, transport & communication, medical and health, etc.This was stated by the
Union Minister of State (Independent Charge) of the Ministry of Development of North Eastern Region (DoNER),
Dr. Jitendra Singh, in written reply to a question in the Lok Sabha on April 4, 2018.

J&K window
GRAM SWARAJ ABHIYAN LAUNCHED IN 8 VILLAGES ALONG LOC IN RAJOURI

D uring the B. R. Ambedkar Jayanti celebrations being held from 14th April to 5th May, 2018 in Jammu and
Kashmir, the district administration of Rajouri has launched Gram Swaraj Abhiyan in the district where under
different activities have been started in 8 targeted border villages in Nowshera from April 15, 2018. The activities
have been started in Sariya, Khamba, Bajnowa, Nonial, Hanjana Thakra, Lam, Rajpur kamila and Qila Darhal
villages. All the field functionaries of Rural Development Department, ICD, Revenue and Education Departments
were assigned the task to sensitise the general public about the campaign and to organise Sabhas in these targeted
villages by maximum participation of public.
The field staff of the RDD has been directed to disseminate the information regarding various RDD schemes
to the people so that they will avail maximum benefits out of these schemes.
On the first day of the Abhiyan the Social Welfare Department identified 18 beneficiaries deserving for financial
assistance under Pradhan Mantri Matritva Vandhana Yojana (PMMVY) in the villages. Revenue department headed
by Tehsildar Nowshera issued 35 income certificates and 26 caste certificates among the people.
The concerned field staff of the School Education Department has been given the task to identify school dropout
students for re-enrolment for ensuring cent percent enrolment of children in these villages. The department has also
been asked to identify SC students for pre and post matric scholarships.
PDD department is also participating in the Abhiyan and have been asked to sensitise public about SUBHAGAYA
scheme (PM’s Sahaj Bijli Har Ghar Yojana).

58 YOJANA May 2018


YE-831/2018

YOJANA May 2018 59


public distribution system
Nutritional Security

Shaping Food Consumption

Pullaiah Dudekula

he National Food Security undernutrition, which shows that more

T Act primarily focuses on


providing food security
via expansion of the PDS.
However, the extent to
which this would lead to nutritional
than half the women of reproductive age
in the country suffer from anaemia. The
Global Nutrition Report 2017, which
looked at 140 countries including India,
found ‘significant burdens’ of three
security depends on how households important forms of malnutrition used
respond to the availability of cheap as an indicator of broader trends. The
cereals. There are two potential effects report tracks global nutrition targets
that PDS subsidies may have on on maternal, infant and young child
When the same households household consumption decisions. nutrition and on diet-related Non-
are compared over time, the Households continually try to balance Communicable Diseases adopted by
trends in food expenditure their various needs including ensuring member states of the World Health
and food consumption vary adequate caloric consumption, Organization as well as governments’
enhancing the quality of their diets, delivery against their commitments. It
between households that aims to make it easier for governments
improving living conditions and
experience income growth investing in the health and education and other stakeholders to make - and
vis-à-vis those that experience of household members. For households deliver on - high impact commitments
income declines. Regardless that value dietary diversity, being able to end malnutrition in all its forms. The
of access to PDS, food to buy cheap cereals will free up money Global Nutrition Report highlights that
expenditure among households to purchase other foods such as milk, the double burden of undernutrition and
that suffer economic distress fruits, nuts, and perhaps eggs and meat obesity needs to be tackled as part of
(income effect). For households that India’s national nutrition strategy.
does not change substantially,
have other dominating consumption
possibly because they economies needs, money saved by purchasing
Public Distribution System
in other areas. However, food subsidized cereals may be devoted to The Public Distribution System
expenditure for households those needs and diverted from food (PDS) in the country facilitates the
experiencing income growth expenditure (substitution effect). supply of food grains and distribution
increases. This suggests that Which effect dominates remains an of essential commodities to a large
food expenditure has a sticky empirical question. number of poor people through a
floor. Growth in incomes leads The Global Nutrition Report 2017 network of Fair Price Shops (FPSs) at
to a higher increase in food shows that, despite the significant steps a subsidized price on a recurring basis.
expenditure by households the world has taken towards improving With a network of more than 4.9 lakh
fair price shops claiming to distribute
without BPL/AAY cards than for nutrition and associated health burdens
annually commodities worth more
those with these cards, even after over recent decades, nutrition is still a
large-scale and universal problem. than Rs. 40,000 crore to about 190
implicit food subsidies are taken million families, the PDS in India is
into account According to the report, India perhaps the largest distribution network
is facing a serious burden of of its type in the world.  The Public
The author is Lecturer in Commerce, Sri Ramakrishna Degree College, Nandyal, Kurnool, Andhra Pradesh.

60 YOJANA May 2018


distribution system (PDS) is an Indian
food Security System for the poor
people established by the Government
of India under the Ministry of Consumer
Affairs, Food, and Public Distribution.
While the Central government is
responsible for procurement, storage,
transportation, and bulk allocation of
food grains, the State governments
hold the responsibility for distributing
the same to the consumers through the
established network of approximately
5 lakh Fair Price Shops. Major
commodities distributed include wheat,
rice, sugar, and kerosene.
The role of PDS in Shaping the
Household and Nutritional Security of the largest safety net programmes in (National Nutrition Monitoring Bureau,
was carried out by the erstwhile the country, was envisaged as a means 2012) and those from the National
Independent Evaluation Office, now of dealing with nutritional deficiency Council of Applied Economic Research
the Development Monitoring and by supplying rice, wheat, sugar and and University of Maryland (Thorat
Evaluation Office, on a request received kerosene at highly subsidized prices to and Desai, 2016).
from the Ministry of Agriculture, the poor. It was launched as a universal
The National Sample Survey (NSS)
Government of India. The study programme in the context of food
data, presented in view of the steady
was designed with an objective to shortages during the early years after
decline in poverty over this period,
explore the effectiveness of PDS in Independence. However, since it was
the decline in cereal consumption is
ensuring food and nutritional security widely criticised for its urban bias, it
puzzling. Caloric consumption also
to the beneficiaries. The other aspects was subsequently streamlined through
seems to have fallen. As suggested by
explored were efficiency in PDS, the the launch of the Targeted PDS (TPDS) Deaton and Drèze (2009), disaggregated
importance of food grains provided to in June 1997, which aimed at providing analysis shows that most of this decline
the beneficiaries, balancing between very poor families access to food grains took place at the upper-income levels,
cereal and non-cereal and food and at reasonably low costs to help them which may be due to a reduction in
non-food expenditures, effects of improve their nutrition standards and physical activity and the resultant
change in income on food expenditure/ attain food security. The National caloric demands.
consumption patterns, etc. Food Security Act also focuses on
providing food security via expansion Coverage of TPDS
Motivation of the PDS. In this context, greater
access to subsidized grains for the poor PDS cards are ubiquitous with
It has been observed that even households that do not own any
though the Indian economy has was expected to reduce malnutrition,
leading to a concomitant fall in the card declining from 19  per cent  to
achieved remarkable economic growth 14  per cent  of the total households
along with a decline in poverty over number of underweight children.
b e t w e e n 2 0 0 4 - 0 5 a n d 2 0 11 - 1 2 .
the last two decades, improvements Income, Food and Nutrition Bureaucratic difficulties are seen
in nutritional status have not kept Puzzles  as being the single most important
pace with this economic growth. The reason for households not having a
National Sample Survey (NSS) data Although we must rely on the card. The proportion of households
also documents that the per capita National Family Health Survey of holding Below Poverty Line (BPL)
cereal consumption steadily declined 2005-06 (International Institute for or Antyodaya Anna Yojana (AAY)
for both the rural and urban population Population Sciences and Macro cards increased from 36  per cent  of
between 1993-94 and 2011-12.The International, 2007) for national data all households to 42 per cent between
reasons for the disjunction between on nutrition, the results from a variety 2004-05 and 2011-12. Much of this
economic advancement and nutritional of other surveys suggest only a modest increase comes from the expansion of
improvement in India by analysing improvement in the proportion of the AAY programme. Although BPL
the role and performance of the underweight children the poverty and AAY card holders come from the
Public Distribution System (PDS) in decline against trends in underweight poorer sections of the society, this
determining food consumption patterns children from the National Family concordance is not perfect. The use of
and nutritional outcomes over a period Health Surveys 1, 2 and 3; surveys the consumption-based poverty line
of time. The PDS, conceptualized as one from the National Institute of Nutrition cut-off suggested by the Tendulkar

YOJANA May 2018 61


Committee indicates that only 29 per
cent of the BPL cardholders are poor
while 71  per cent  are not poor. In
contrast, about 13 per cent of the APL
cardholders  are  poor while 87  per
cent are not poor. Thus, many non-poor
have BPL cards while some of the poor
are excluded from the ownership of
BPL cards.

Access and Use of the TPDS


There was a striking rise in PDS
use between 2004-05 and 2011-12.
In 2011-12, about 27 per cent of all
households purchased cereals from
the PDS whereas, by 2011-12, this
proportion had risen to 52.3 per cent. Use of Propensity Score Matching statistically significant. Households
Every category of cardholders has as an Analytical Technique with BPL/AAY cards are ostensibly
recorded a growth in PDS use during trying to obtain their caloric needs
In order to examine if the TPDS is from cheaper cereals rather than from
the period under study. While almost the best way of enhancing food security
all the BPL and AAY cardholders are more expensive items like dairy, fruits,
for all households, it is important to nuts and meats. Rising incomes lead
seen to purchase PDS grains, as many compare households with access to
as 32 per cent of the Above Poverty to greater dietary diversification for
food subsidies to those without such households without BPL cards than the
Line (APL) cardholders also use the access, while holding income constant.
PDS. Despite the increase in the use matched households with BPL cards.
However, this is a difficult proposition
of PDS by the purchasing households, due to the general lack of availability of Shaping Food Consumption
the amount of purchase or the share of data on household income. The India
PDS grain to the total grain consumed Human Development Surveys I and When the same households are
has remained more or less stable. II contain detailed data on household compared over time, the trends in food
expenditure and food consumption vary
PDS use increased not just for income as well as a brief consumption
between households that experience
food grains but also for kerosene, expenditure module that allows for
income growth vis-à-vis those that
with 79  per cent  of the PDS card an analysis of different aspects of
experience income declines. Regardless
holders purchasing kerosene from consumption.
of access to PDS, food expenditure
PDS shops. Although the use of
Role of BPL/AAY Subsidies in among households that suffer economic
kerosene as a primary cooking fuel distress does not change substantially,
Shaping Food Expenditure
is negligible, nearly 28  per cent  of possibly  because  they economies in
the households  uses  kerosene in Application of the Propensity other areas. However, food expenditure
conjunction with biomass (e.g. Score Matching (PSM) techniques for households experiencing income
firewood) and LPG. highlights notable distinctions between growth increases. This suggests
consumption patterns of households that food expenditure has a sticky
Targeting Efficiency with BPL/AAY cards and those not floor. Growth in incomes leads to a
Exclusion errors in PDS targeting having access to these cards. The higher increase in food expenditure
have declined between 2004-05 and results show that at any given income by households without BPL/AAY
2011-12 while inclusion errors have level, households with BPL/AAY cards than for those with these cards,
increased. However, both types of cards are more likely to buy cereals even after implicit food subsidies
errors remain high. This change can from PDS shops than those with APL are taken into account. While all
be attributed both to a decrease in cards. Since only BPL cardholders households experiencing substantial
the poverty levels as well as a slight are eligible for subsidized cereals, income growth increase their cereal
increase in the number of cards being this is not surprising. The expenditure consumption, this increase is lower for
distributed to the whole population. incurred on food by households households without BPL/AAY cards as
Inclusion errors increased across all with BPL/AAY cards is less than the compared to those with these cards.
regions between 2004-05 and 2011- corresponding expenditure incurred
National Food Security Act, 2013
12 and were particularly high for the by their counterparts who do not have
Southern states.  While exclusion errors these cards. Once implicit subsidies The National Food Security Act,
are decreasing, they remain highest for via PDS transfers are factored in, 2013 (NFSA) was enacted by the
the marginalized groups. this difference is smaller but remains Government in the year 2013 to

62 YOJANA May 2018


provide for food and nutritional explore the possibility of introducing the highest number of people with
security in human life cycle approach, innovative ideas such as smart cards, diabetes in the world, and this burden
by ensuring access to adequate quantity food credit/debit cards, food stamps has been rising over time, which is
of quality food at affordable prices to and decentralized procurement, to why it is sometimes referred to as the
people to live a life with dignity. The eliminate hunger and make food ‘diabetic capital of the world’. At least
Act inter alia entitles up to 75 per available to the poor wherever they some of this increase in the occurrence
cent of the rural population and up to may be in a cost-effective manner. of the disease could be due to the rising
50 per cent of the urban population consumption of processed foods and
for receiving subsidized food grains The results presented in this status refined foodgrains as unprocessed
under TPDS, thus covering about thus paint a complex picture of the foods and healthier cereals like small
two-thirds of the population. Eligible TPDS programmed. While on the millets are considered inferior foods
households comprise of priority one hand, the rising proportion of the that households abandon as they get
households and  Antyodaya Anna Indian population relying on the TPDS rich.  Nutrition challenges continue
Yojana (AAY) households. Persons for procuring subsidised cereals points throughout the life cycle, particularly
belonging to priority households are to the ubiquity of the TPDS, it also or girls and women. A woman with poor
entitled to receive 5 kg of foodgrains has alarming implications in terms nutritional status, as indicated by a low
per person per month at subsidized of skewing the dietary composition body mass index, short nature anaemia,
prices of `3/2/1 per kg. for rice/wheat/ of households by increasing their or other micronutrient deficiencies,
coarse grains. AAY households, which cereal consumption. This poses a has a greater risk of obstructed labour,
constitute the poorest of the poor, will critical problem particularly for a having a baby  with a low birth weight,
continue to receive 35 kg. of food society facing an epidemiological having adverse pregnancy outcomes,
grains per household per month @ transition from the dominance of adversely lactation, death due to
`3/2/1 per kg., for rice/wheat/coarse
communicable diseases to the rise in postpartum hemorrhage, and illness
grains. non-communicable diseases (NCDs) for herself and her baby.  q
like cardiovascular diseases, strokes,
The PDS needs to be effectively diabetes and cancer, the four leading (E-mail: pullaiahapril20@gmail.com)
monitored and there is a need to NCDs in India. The country also has

SWACHH BHARAT GRAMIN CONFIRMS 93 PER CENT USAGE OF TOILETS 


The National Annual Rural Sanitation Survey (NARSS) 2017-18,
conducted by an Independent Verification Agency (IVA) under the
World Bank support project to the Swachh Bharat Mission Gramin
(SBM-G), has found that 93.4 per cent of the households in rural
India who have access to a toilet use it. The NARSS also re-
confirmed the Open Defecation Free (ODF) status of 95.6 per cent
of villages which were previously declared and verified as ODF
by various districts/states.The survey was conducted between
mid-November 2017 and mid-March 2018 and covered 92040
households in 6136 villages across States and UTs of India.
The key findings of NARSS 2017-18 are as follows:
• 77 per cent of households were found to have access to toilets during the survey period
• 93.4 per cent of the people who had access to toilets used them
• 95.6 per cent of villages which were previously declared and verified as ODF were confirmed to be ODF. The
remaining 4.4 per cent villages also had sanitation coverage of over 95 per cent 70 per cent of the villages
surveyed found to have minimal litter and minimal stagnant water
The IVA presented their findings to the Expert Working Group (EWG) constituted for oversight of NARSS. The
EWG noted the satisfactory completion of the survey. Since its launch in October 2014, the SBM, the world’s
largest sanitation program, has changed the behaviour of hundreds of millions of people with respect to toilet
access and usage. 300 million people have stopped defecating in the open since the SBM began, down from 550
million at the beginning of the programme to about 200 million today. Over 6.5 crore toilets have been built across
rural India under the Mission. Over 3.38 lakh villages and 338 districts have been declared ODF, along with 9
ODF States and 3 Union Territories, namely Sikkim, Himachal Pradesh, Kerala, Haryana, Uttarakhand, Gujarat,
Arunachal Pradesh, Chhattisgarh, Meghalaya, Chandigarh, Daman & Diu and Dadra and Nagar Haveli.

YOJANA May 2018 63


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Gandhi in Champaran (Tamil)


Author: DG Tendulkar
Price: Rs. 160

T his heritage publication details the account of Mahatma Gandhi’s first


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the Champaran district of Bihar, Mahatma Gandhi mobilised farmers who were
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narrates Gandhi’s first battle of civil disobedience on Indian soil and how this
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Price: Rs. 90

T here are many aspects of Gandhiji’s life which are normally not discussed
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with his wife, the book mentions those personal instances of Bapu’s life which
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title ‘Bapu ke Saath’, published in Hindi.

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66 YOJANA May 2018